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General NPI Number Information
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NPI Number | 1265521058
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Entity Type | Individual
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Provider Name | RAVI K KODURU M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1332 N 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1004
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Country | US
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Telephone | 812-478-8888
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Fax | 812-478-1114
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Provider Business Mailing Address
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Address Line | 264 E TRAILWOOD DR
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City | TERRE HAUTE
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State | IN
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Zip | 47802-9606
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Country | US
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Telephone | 812-478-8888
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Fax | 812-478-1114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01057643A
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License Number State | IN
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