Provider Demographics
NPI:1780841817
Name:MADABHUSHI, MADHURI (MD)
Entity type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:MADABHUSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHURI
Other - Middle Name:
Other - Last Name:GUDIHALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39400 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2310
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:15803 WINDERMERE DR STE 103
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2482
Practice Address - Country:US
Practice Address - Phone:512-989-2680
Practice Address - Fax:512-989-0953
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119479207Q00000X
TXN3153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210701304Medicaid
TX210701303Medicaid
TX210701304Medicaid
R02892Medicare PIN
TXTXB126664Medicare PIN
TXP01022976Medicare PIN