Provider Demographics
NPI:1457557290
Name:MUPPALA, SRI DIVYA (MD)
Entity type:Individual
Prefix:
First Name:SRI DIVYA
Middle Name:
Last Name:MUPPALA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:2091 N BEND RD
Practice Address - Street 2:HEBRON
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9691
Practice Address - Country:US
Practice Address - Phone:859-586-2200
Practice Address - Fax:859-586-4222
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2013-09-13
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Provider Licenses
StateLicense IDTaxonomies
MO2007013992207R00000X
KY44863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine