Healthcare Provider Details

I. General information

NPI: 1053686808
Provider Name (Legal Business Name): REDDY RUPA PALLAVALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 11/27/2023
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S STATE ROAD 135 SUITE 310
GREENWOOD IN
46143-9825
US

IV. Provider business mailing address

6626 E. 75TH STREET SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-2400
  • Fax: 317-497-2515
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 State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01073752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: