Provider Demographics
NPI:1881937290
Name:VUPPALA, AMRITA-AMANDA DEVI (MD)
Entity type:Individual
Prefix:DR
First Name:AMRITA-AMANDA
Middle Name:DEVI
Last Name:VUPPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMRITA-AMANDA
Other - Middle Name:DEVI
Other - Last Name:LAKRAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:925 N 87TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4812
Mailing Address - Country:US
Mailing Address - Phone:414-955-2020
Mailing Address - Fax:414-955-6300
Practice Address - Street 1:925 N 87TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4812
Practice Address - Country:US
Practice Address - Phone:414-955-2020
Practice Address - Fax:414-955-6300
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI637082084N0400X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881937290Medicaid