Individual
HAREN BODEPUDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10050 SW INNOVATION WAY STE 102, PORT ST LUCIE, FL 34987-2117
(772) 344-3811
(772) 344-3890
Mailing address
PO BOX 9033, STUART, FL 34995-9033
(772) 223-2832
(772) 781-2716
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME145133
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106666500
—
FL
Enumeration date
03/27/2015
Last updated
04/22/2021
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