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NPI Code Detail

MEDICARE: DR. RAVI K KODURU M.D.

MEDICARE: DR. RAVI K KODURU 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
1207R00000XInternal Medicine Physician01057643AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00057068OTHERINRR MEDICARE
2P01045883OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3000000299607OTHERINCOMMERCIAL
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265521058
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAVI K KODURU M.D.
Provider Business Mailing Address
First Line : 264 E TRAILWOOD DR
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47802-9606
Country : US
Telephone Number : 812-478-8888
Fax Number : 812-478-1114
Provider Business Practice Location Address
First Line : 1332 N 7TH ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47807-1004
Country : US
Telephone Number : 812-478-8888
Fax Number : 812-478-1114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/19/2012

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