Healthcare Provider Details

I. General information

NPI: 1043283021
Provider Name (Legal Business Name): NARAHARISETTY LEELA RAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/27/2023
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

850 N MERIDIAN ST
INDIANAPOLIS IN
46204-1098
US

V. Phone/Fax

Practice location:
  • Phone: 317-612-2727
  • Fax: 317-612-2727
Mailing address:
  • Phone: 317-612-2727
  • Fax: 317-554-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01030804
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: