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NPI Code Detail

MEDICARE: MIDWEST WELLNESS LLC

MEDICARE: MIDWEST WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RB0002XObesity Medicine (Internal Medicine) Physician
2207R00000XInternal Medicine PhysicianIN

General Provider Information

NPI Number : 1497108468
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST WELLNESS LLC
Provider Business Mailing Address
First Line : 6822 E 82ND ST
Second Line : SUITE 310
City : INDIANAPOLIS
State : IN
Zip : 46250-1676
Country : US
Telephone Number : 317-548-4666
Fax Number :
Provider Business Practice Location Address
First Line : 6822 E 82ND ST
Second Line : SUITE 310
City : INDIANAPOLIS
State : IN
Zip : 46250-1676
Country : US
Telephone Number : 317-548-4666
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. SRINIVASU KESA
Credential : MD
Telephone Number : 317-548-4666
Provider Enumeration Date : 07/14/2016
Last Update Date : 07/14/2016

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Directions to “MIDWEST WELLNESS LLC ” Practice Location

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