Healthcare Provider Details

I. General information

NPI: 1427058551
Provider Name (Legal Business Name): ARUNA UPPULURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 COLUMBIA AVENUE
MUNSTER IN
46321-2907
US

IV. Provider business mailing address

9660 WICKER AVENUE
ST JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5040
  • Fax: 219-836-6835
Mailing address:
  • Phone: 219-365-1166
  • Fax: 219-226-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01059101A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: