Provider Demographics
NPI:1215153879
Name:MARIYAPPA, ANU KELUR (MD)
Entity type:Individual
Prefix:DR
First Name:ANU
Middle Name:KELUR
Last Name:MARIYAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131083
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-1083
Mailing Address - Country:US
Mailing Address - Phone:281-475-3150
Mailing Address - Fax:
Practice Address - Street 1:129 VISION PARK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3024
Practice Address - Country:US
Practice Address - Phone:281-825-3344
Practice Address - Fax:281-825-3340
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42592207R00000X
IL036136161208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ494987Medicaid
AZ494987Medicaid