Provider Demographics
NPI:1366510018
Name:KUNCHARAPU, INDUMATHI (MD)
Entity type:Individual
Prefix:
First Name:INDUMATHI
Middle Name:
Last Name:KUNCHARAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 MESA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7043
Mailing Address - Country:US
Mailing Address - Phone:832-738-1076
Mailing Address - Fax:832-738-1076
Practice Address - Street 1:1517 MESA VERDE DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7043
Practice Address - Country:US
Practice Address - Phone:832-738-1076
Practice Address - Fax:832-738-1076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3289207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG52704Medicare UPIN