# LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PC
- **Other names:** Dell Range Pediatrics
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205386281
- **Legal business name:** LARAMIE PEDIATRICS/LARAMIE INTERNAL MEDICINE PC
- **Authorized official:** VIJAYA MADHAVI KODURI M.D (OWNER)
- **Authorized official phone:** (307) 365-8789

## Contact information

- **Practice address:** 1252 N. 22ND STREET, SUITE B, LARAMIE, WY 82072
- **Practice address phone:** (307) 745-3704
- **Mailing address:** 1252 N. 22ND STREET, SUITE B, LARAMIE, WY 82072
- **Mailing address phone:** (307) 745-3704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | WY | — |

## Other

- **Enumeration date:** 10/13/2016
- **Last updated:** 03/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1558672253 | — | WY |