Healthcare Provider Details

I. General information

NPI: 1457646135
Provider Name (Legal Business Name): GIRISH CHANDRA KUNAPAREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 N 6TH 1/2 ST STE 202
TERRE HAUTE IN
47804-2766
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3700
  • Fax: 812-234-3565
Mailing address:
  • Phone: 812-242-3157
  • Fax: 812-242-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01074185A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: