Healthcare Provider Details

I. General information

NPI: 1154375871
Provider Name (Legal Business Name): DEEPTI RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 CLEARVISTA PARKWAY
INDIANAPOLIS IN
46256-4621
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 317-621-5100
  • Fax: 317-621-7896
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01059177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: