Healthcare Provider Details

I. General information

NPI: 1336870534
Provider Name (Legal Business Name): SWARA MANASA SARVEPALLI MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 W MICHIGAN ST ST 212
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1412 MORNING MIST
MT PLEASANT MI
48858-7006
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2128
  • Fax:
Mailing address:
  • Phone: 989-954-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: