Basic Information
| Provider Information | |||||||||
| NPI: | 1447412788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALLURUPALLI | ||||||||
| FirstName: | SANTARAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 STANTON L YOUNG BLVD | ||||||||
| Address2: | SUITE WP 1380 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052714426 | ||||||||
| FaxNumber: | 4052713074 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 STANTON L YOUNG BLVD | ||||||||
| Address2: | SUITE WP 1380 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052714426 | ||||||||
| FaxNumber: | 4052713074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2008015178 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 121194 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 30833 | OK | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 121194 | 01 | OH | STATE BOARD OF OHIO | OTHER | 2008015178 | 01 | MO | MEDICAL LICENSE | OTHER | 30833 | 01 | OK | OKLAHOMA MEDICAL BOARD | OTHER |