Healthcare Provider Details

I. General information

NPI: 1003884404
Provider Name (Legal Business Name): SRINIVASU KESA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KESA SRINIVASU MD

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 MUIRFIELD WAY
CARMEL IN
46032
US

IV. Provider business mailing address

3471 MUIRFIELD WAY STE. 400
CARMEL IN
46032-9375
US

V. Phone/Fax

Practice location:
  • Phone: 317-850-7725
  • Fax:
Mailing address:
  • Phone: 317-850-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01056280A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number01056280 A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: