Provider Demographics
NPI:1043303084
Name:UDUPA, ANAND DEVIPRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:DEVIPRAKASH
Last Name:UDUPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-2763
Mailing Address - Fax:918-481-2775
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-2760
Practice Address - Fax:918-481-2775
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK21103207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100026940AMedicaid
OK100026940AMedicaid
G93904Medicare UPIN