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Organization
ALTUS DIRECT, LLC
Active
Organization
ALTUS DIRECT, LLC
Active
Other names
SUPRO DIRECT
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVEEN RAJANAHALLI MD (TIN OWNER)
(317) 300-7424
Entity
Organization
Contact information
Practice address
1040 GREENWOOD SPRINGS BLVD, STE 1A, GREENWOOD, IN 46143
(317) 300-7424
(317) 360-6245
Mailing address
1040 GREENWOOD SPRINGS BLVD, STE 1A, GREENWOOD, IN 46143
(317) 300-7424
(317) 360-6245
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
02/06/2017
Last updated
09/17/2026
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