Healthcare Provider Details

I. General information

NPI: 1104180793
Provider Name (Legal Business Name): VINDHYA LAKSHMI VEERULA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST # M200
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

1001 W 10TH ST # M200
INDIANAPOLIS IN
46202-2859
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-4260
  • Fax:
Mailing address:
  • Phone: 317-656-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11016587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: