Individual
SIVAPRASAD D MADDURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2210 BARRON RD, SUITE 216, POPLAR BLUFF, MO 63901-1908
(573) 686-4133
(573) 686-1298
Mailing address
2210 BARRON RD, SUITE 216, POPLAR BLUFF, MO 63901-1908
(573) 686-4133
(573) 686-1298
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
R7648
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108024001
ARKANSAS MEDICAID
AR
05
—
200297117
—
MO
Enumeration date
01/04/2006
Last updated
10/01/2013
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