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Individual

DR. BEULAH T. PENUMUDI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2121 LAKE AVE, VA NORTHERN INDIANA HEALTH CARE SYSTEM, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 426-5431
Mailing address
2121 LAKE AVE, VA NORTHERN INDIANA HEALTH CARE SYSTEM, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 426-5431

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11433
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11433
NEVADA MEDICAL LICENSE
NV
01
CS12529
PHARMACY LICENSE
NV
Enumeration date
01/18/2007
Last updated
03/07/2023
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