IndividualActive
Brahmananda Koduri, M.D
NPI 1659608214 · Pediatric Critical Care Medicine Physician · Gillette, WY
Provider details
- NPI number
- 1659608214
- Entity type
- Individual
- Primary specialty
- Pediatric Critical Care Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D
- Sex
- Male
- Sole proprietor
- No
- License
- 9302A (WY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
501 S Burma Ave
Gillette, WY 82716-3426
Phone: (307) 688-1534
Street-level locationGet directions
Mailing address
4516 Running W Dr Apt 101
Gillette, WY 82718-2033
Registry dates
- Enumerated
- 2009-11-03
- Last updated
- 2013-09-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.