MEDICARE: GIRIDHAR RAO VEERULA

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	174400000X	Specialist	01043132	IN

General Provider Information

NPI Number	:	1154421303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIRIDHAR RAO VEERULA

Provider Business Mailing Address
First Line	:	3919 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6811
Country	:	US
Telephone Number	:	260-436-7722
Fax Number	:	260-459-0012

Provider Business Practice Location Address
First Line	:	3919 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6811
Country	:	US
Telephone Number	:	260-436-7722
Fax Number	:	260-459-0012

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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Directions to “ GIRIDHAR RAO VEERULA ” Practice Location

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