Healthcare Provider Details

I. General information

NPI: 1093374258
Provider Name (Legal Business Name): SARVANI SURAPANENI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date: 01/17/2020
Reactivation Date: 04/29/2020

III. Provider practice location address

2525 W UNIVERSITY AVE STE 300
MUNCIE IN
47303-3432
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-289-5408
  • Fax: 765-289-5346
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01099904A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01099904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: