Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 24904 | AL |
NPI | 1033163308 |
---|---|
Provider Name | Sudhakar G. Madanagopal |
First Address | Huntsville, AL 35801-4306 |
Second Address | Huntsville, AL 35801-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 26/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173820 | (05) | AL |
511-61554 | BCBS (01) | AL |
H74948 | (02) |