Healthcare Provider Details

I. General information

NPI: 1124133806
Provider Name (Legal Business Name): VIKRAM APPANNAGARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 LAPORTE AVE
VALPARAISO IN
46383-5860
US

IV. Provider business mailing address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-7151
  • Fax:
Mailing address:
  • Phone: 219-934-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01040899
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: