Healthcare Provider Details

I. General information

NPI: 1457490351
Provider Name (Legal Business Name): LEELARANI CHIGURUPATI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

323 QUAIL DR
HOBART IN
46342-2362
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4655
  • Fax: 219-886-4580
Mailing address:
  • Phone: 219-942-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001338A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: