# RAGHURAM DASARI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1417939885
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | 01060158A | IN | Yes |

## Other

- **Enumeration date:** 11/18/2005
- **Last updated:** 09/14/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000496942 | BLUE CROSS BLUE SHIELD IN | — |
| 05 | — | 200506520 | — | IN |
| 01 | — | 90000561 | BLUE SHIELD OF IL | — |
| 01 | — | P00369368 | RAILROAD MEDICARE | — |