Healthcare Provider Details

I. General information

NPI: 1821520198
Provider Name (Legal Business Name): CHETAN VELAGAPUDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 BROADWAY
MERRILLVILLE IN
46410-7035
US

IV. Provider business mailing address

8701 BROADWAY
MERRILLVILLE IN
46410-7035
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036153361
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01089171A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: