MEDICARE: DR. ANURADHA G BOMMAKANTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME180941	FL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME180941	FL
3	207R00000X	Internal Medicine Physician	E-19237	AR
4	390200000X	Student in an Organized Health Care Education/Training Program
5	207RP1001X	Pulmonary Disease Physician	01087946A	IN
6	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01087946A	IN
7	207R00000X	Internal Medicine Physician	01087946B	IN
8	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	E-19237	AR
9	207RP1001X	Pulmonary Disease Physician	E-19237	AR

General Provider Information

NPI Number	:	1003265455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANURADHA G BOMMAKANTI M.D.

Provider Business Mailing Address
First Line	:	7950 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-435-7001
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-435-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	05/28/2026

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