MEDICARE: GEORGIA K DORULLA 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	2085R0202X	Diagnostic Radiology Physician	1042298	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P00032566	OTHER	RAILROAD MEDICARE
2	P00408569	OTHER	RAILROAD MEDICARE
3	P00033126	OTHER	RAILROAD MEDICARE
4	P00033113	OTHER	RAILROAD MEDICARE
5	P00033114	OTHER	RAILROAD MEDICARE
6	P00032765	OTHER	RAILROAD MEDICARE
7	P00033093	OTHER	RAILROAD MEDICARE
9	P00032884	OTHER	RAILROAD MEDICARE
10	P00032561	OTHER	RAILROAD MEDICARE
11	P00032996	OTHER	RAILROAD MEDICARE
12	P00032995	OTHER	RAILROAD MEDICARE
13	P00033075	OTHER	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	000000109950	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1700870722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA K DORULLA MD

Provider Business Mailing Address
First Line	:	1500 ALBANY ST
Second Line	:	SUITE 906
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-1557
Country	:	US
Telephone Number	:	317-787-3296
Fax Number	:	317-783-4107

Provider Business Practice Location Address
First Line	:	1500 ALBANY ST
Second Line	:	SUITE 906
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-1557
Country	:	US
Telephone Number	:	317-787-3296
Fax Number	:	317-783-4107

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/09/2008

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Directions to “ GEORGIA K DORULLA MD” Practice Location

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