Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 38521 | AL |
N | 207RP1001X | Pulmonary Disease | 38521 | AL |
NPI | 1003256900 |
---|---|
Provider Name | Tarun Kukkadapu |
First Address | Huntsville, AL 35804-2705 |
Second Address | Huntsville, AL 35801-5029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 20/09/2019 |