Basic Information
| Provider Information | |||||||||
| NPI: | 1629059431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHUPALAM | ||||||||
| FirstName: | LEELA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950237 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022382801 | ||||||||
| FaxNumber: | 5022382835 | ||||||||
| Practice Location | |||||||||
| Address1: | 4003 KRESGE WAY | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028971166 | ||||||||
| FaxNumber: | 5028971461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 29062 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 64290620 | 05 | KY | MEDICAID | 50027633 | 01 | KY | PASSPORT | OTHER | 000000652541 | 01 | KY | ANTHEM | OTHER | 3770175000 | 01 | KY | PASSPORT ADVANTAGE | OTHER |