Healthcare Provider Details

I. General information

NPI: 1457523151
Provider Name (Legal Business Name): RAVI JULURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 RONALD REAGAN PKWY SUITE 206
AVON IN
46123-6911
US

IV. Provider business mailing address

950 N MERIDIAN ST STE 500 PROVIDER ENROLLMENT
INDIANAPOLIS IN
46204-3908
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-8050
  • Fax: 317-272-8051
Mailing address:
  • Phone: 317-962-4946
  • Fax: 317-962-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.124233
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01063576A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: