MEDICARE: DR. RAVISHANKAR VEDANTAM MD

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	01046839A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114992237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVISHANKAR VEDANTAM MD

Provider Business Mailing Address
First Line	:	PO BOX 1643
Second Line	:	CENTRAL INDIANA ORTHOPEDICS, PC
City	:	MUNCIE
State	:	IN
Zip	:	47308-1643
Country	:	US
Telephone Number	:	765-284-7738
Fax Number	:	765-284-4266

Provider Business Practice Location Address
First Line	:	1050 REID PARKWAY, SUITE 100
Second Line	:	CENTRAL INDIANA ORTHOPEDICS, PC
City	:	RICHMOND
State	:	IN
Zip	:	47374-1156
Country	:	US
Telephone Number	:	765-983-3373
Fax Number	:	765-983-3413

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/06/2015

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Directions to “ DR. RAVISHANKAR VEDANTAM MD” Practice Location

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