MEDICARE: INDI VASUDEVA SERVICES INC

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
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1528267937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDI VASUDEVA SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 3877
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60434-3877
Country	:	US
Telephone Number	:	815-714-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 W FLETCHER AVE STE 107
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3308
Country	:	US
Telephone Number	:	813-961-6633
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MORUFU ALAUSA
Credential	:
Telephone Number	:	815-714-7171

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	09/15/2022

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