Healthcare Provider Details

I. General information

NPI: 1164884565
Provider Name (Legal Business Name): RAVINDRAKUMAR ALAGUGURUSAMY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 S SCATTERFIELD RD
ANDERSON IN
46013-1802
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-4790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01100278A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: