Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301096459 | MI |
N | 111NI0900X | Internist | 4301096459 | MI |
N | 207R00000X | Internist | 47473 | AZ |
N | 111NI0900X | Internist | 47473 | AZ |
NPI | 1003123530 |
---|---|
Provider Name | Vidyasagargoud Marupakula |
First Address | Gilbert, AZ 85234 |
Second Address | Gilbert, AZ 85234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 15/06/2021 |