Basic Information
| Provider Information | |||||||||
| NPI: | 1295715845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUCHIPUDI | ||||||||
| FirstName: | SARAT | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 COMMERCE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984575 | ||||||||
| FaxNumber: | 4199984586 | ||||||||
| Practice Location | |||||||||
| Address1: | 528 W MARKET ST | ||||||||
| Address2: | SUITE 200A | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458014762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192277378 | ||||||||
| FaxNumber: | 4192271370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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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 | 174400000X | 35.074270 | OH | Y | Other Service Providers | Specialist |
No ID Information.