Healthcare Provider Details

I. General information

NPI: 1447954730
Provider Name (Legal Business Name): DR. RAHUL PEDAGANDHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 ORTHOPAEDIC DR
NEWBURGH IN
47630-7955
US

IV. Provider business mailing address

PO BOX 328
EVANSVILLE IN
47702-0328
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-9291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001513A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: