Provider Demographics
NPI:1528544327
Name:GUNTUPALLI, SRI VIBHAVARI
Entity type:Individual
Prefix:
First Name:SRI VIBHAVARI
Middle Name:
Last Name:GUNTUPALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 NERREDIA ST STE E
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4807
Mailing Address - Country:US
Mailing Address - Phone:810-230-9901
Mailing Address - Fax:810-230-9916
Practice Address - Street 1:2486 NERREDIA ST STE E
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4807
Practice Address - Country:US
Practice Address - Phone:810-230-9901
Practice Address - Fax:810-230-9916
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511238207RN0300X
MA275735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty