Healthcare Provider Details

I. General information

NPI: 1992624548
Provider Name (Legal Business Name): RAJIV DUTT KALLURI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10326 HAMPSHIRE CT
MUNSTER IN
46321-2846
US

IV. Provider business mailing address

10326 HAMPSHIRE CT
MUNSTER IN
46321-2846
US

V. Phone/Fax

Practice location:
  • Phone: 219-779-0342
  • Fax:
Mailing address:
  • Phone: 219-779-0342
  • 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 StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: