Basic Information
| Provider Information | |||||||||
| NPI: | 1467770933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORUPOLU | ||||||||
| FirstName: | RADHA | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 MOURSUND ST | ||||||||
| Address2: | TIRR MEMORIAL HERMANN HOSPITAL | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303405 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1333 MOURSUND ST | ||||||||
| Address2: | TIRR MEMORIAL HERMANN HOSPITAL | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137997024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2010 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Q4166 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P0004X | Q4166 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine |
No ID Information.