Basic Information
| Provider Information | |||||||||
| NPI: | 1659353829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATLURI | ||||||||
| FirstName: | SAIRAM | ||||||||
| MiddleName: | L | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7655 5 MILE RD STE 117 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136247525 | ||||||||
| FaxNumber: | 5136240578 | ||||||||
| Practice Location | |||||||||
| Address1: | 7655 5 MILE RD STE 117 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136247525 | ||||||||
| FaxNumber: | 5136240578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 35068859A | OH | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000350928 | 01 | ANTHEM BLUE SHIELD | OTHER | 64059264 | 05 | KY | MEDICAID | 610168000 | 01 | FEDERAL WORKERS COMP | OTHER | 10818917 | 01 | CAQH | OTHER | 2044773 | 05 | OH | MEDICAID | 5757645 | 01 | AETNA | OTHER | 200377720 | 05 | IN | MEDICAID | 352199392 | 01 | BUREAU OF WORKERS COMP | OTHER |