Basic Information
| Provider Information | |||||||||
| NPI: | 1164669305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCHIPUDI | ||||||||
| FirstName: | RAMI REDDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 HARRIS PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761324101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178204906 | ||||||||
| FaxNumber: | 8178204815 | ||||||||
| Practice Location | |||||||||
| Address1: | 5021 TAFT BLVD APT 3301 | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763085391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402326878 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 12/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N3521 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 206843901 | 05 | TX | MEDICAID | 8V4249 | 01 | TX | BCBS | OTHER | P00834994 | 01 | TX | RR MEDICARE | OTHER |