Provider Demographics
NPI:1548469190
Name:PUPPALA, SIRISHA (MD)
Entity type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:PUPPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SIRISHA
Other - Middle Name:
Other - Last Name:SAVARAPU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3285 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7000
Mailing Address - Country:US
Mailing Address - Phone:480-825-7219
Mailing Address - Fax:
Practice Address - Street 1:3285 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7000
Practice Address - Country:US
Practice Address - Phone:480-825-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088551207QA0505X
AZ43258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ567495Medicaid
AZ567495Medicaid
AZZ148859Medicare PIN