Provider Demographics
NPI:1972651305
Name:MUNUKUTI, PADMA NAGALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:PADMA
Middle Name:NAGALAKSHMI
Last Name:MUNUKUTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAGALAKSHMI
Other - Middle Name:PADMA
Other - Last Name:MUNUKUTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2609 WINDING PATH WAY STE 700
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5348
Mailing Address - Country:US
Mailing Address - Phone:678-264-9441
Mailing Address - Fax:
Practice Address - Street 1:11 UPPER RIVERDALE RD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2615
Practice Address - Country:US
Practice Address - Phone:770-897-7107
Practice Address - Fax:770-897-7109
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058372208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I70408Medicare UPIN