Healthcare Provider Details

I. General information

NPI: 1033563614
Provider Name (Legal Business Name): VARUN CHOWDARY KONERU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

IV. Provider business mailing address

1150 KINGSWOOD RD S
WEST LAFAYETTE IN
47906-4671
US

V. Phone/Fax

Practice location:
  • Phone: 765-364-3132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01082511A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: