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General NPI Number Information
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NPI Number | 1689697757
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Entity Type | Individual
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Provider Name | SUE PALLEKONDA MD, MBBS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/27/2023
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Provider Practice Location Address
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Address Line | 9820 E 141ST ST STE 100
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City | FISHERS
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State | IN
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Zip | 46038-9303
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Country | US
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Telephone | 317-794-2432
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Fax | 317-799-9669
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Provider Business Mailing Address
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Address Line | 6340 WOBURN DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2742
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Country | US
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Telephone | 317-599-7681
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01058024A
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License Number State | IN
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