Basic Information
| Provider Information | |||||||||
| NPI: | 1457555021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNAPULI | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 18220 TOMBALL PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770704347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134419909 | ||||||||
| FaxNumber: | 2817370968 | ||||||||
| Practice Location | |||||||||
| Address1: | 18220 TOMBALL PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770704347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134419909 | ||||||||
| FaxNumber: | 2817370968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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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 | 207RI0011X | N3805 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | BP3-0026823 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | N3805 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P01048884 | 01 | TX | RR MEDICARE | OTHER | 215084901 | 05 | TX | MEDICAID | 1457555021 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | P00919307 | 01 | TX | MEDICARE RR | OTHER | 215084902 | 05 | TX | MEDICAID | 8CJ363 | 01 | TX | BCBS | OTHER | P01309422 | 01 | TX | RR MEDICARE | OTHER | 215084904 | 05 | TX | MEDICAID |