Provider Demographics
NPI:1306937438
Name:PULUSANI, DEEPIKA REDDY (MD)
Entity type:Individual
Prefix:MRS
First Name:DEEPIKA
Middle Name:REDDY
Last Name:PULUSANI
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 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-767-0402
Mailing Address - Fax:901-767-0414
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 511
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-767-0402
Practice Address - Fax:901-767-0414
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE87970Medicare UPIN
TN3808282Medicare ID - Type Unspecified