MEDICARE: INDIRA KEDLAYA 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	207R00000X	Internal Medicine Physician	A067008	CA
2	207R00000X	Internal Medicine Physician	44387	CO

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

General Provider Information

NPI Number	:	1891771382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIRA KEDLAYA MD

Provider Business Mailing Address
First Line	:	1600 N GRAND AVE STE 120
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2755
Country	:	US
Telephone Number	:	719-545-9292
Fax Number	:	719-545-9191

Provider Business Practice Location Address
First Line	:	1600 N GRAND AVE STE 120
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2755
Country	:	US
Telephone Number	:	719-545-9292
Fax Number	:	719-545-9191

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	02/11/2008

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Directions to “ INDIRA KEDLAYA MD” Practice Location

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