Healthcare Provider Details

I. General information

NPI: 1265549281
Provider Name (Legal Business Name): RAMIREDDY K TUMMURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 LAPORTE AVE
VALPARAISO IN
46383-5860
US

IV. Provider business mailing address

PO BOX 10806
MERRILLVILLE IN
46411-0806
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-7151
  • Fax:
Mailing address:
  • Phone: 570-647-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01036599
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: