Provider Demographics
NPI:1023114154
Name:SHIVAPRASAD, HULLUKUNTE BYLAPPA (MD)
Entity type:Individual
Prefix:
First Name:HULLUKUNTE
Middle Name:BYLAPPA
Last Name:SHIVAPRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SCIOTO TRAIL
Mailing Address - Street 2:STE 200
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-353-8100
Mailing Address - Fax:740-353-8908
Practice Address - Street 1:2001 SCIOTO TRAIL
Practice Address - Street 2:STE 200
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-353-8100
Practice Address - Fax:740-353-8908
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044638S207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64114994Medicaid
OH0464788Medicaid
OH0464788Medicaid
KY64114994Medicaid
OH4146941Medicare PIN