# DIAMOND MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790297935
- **Authorized official:** BENERJI GUDAPATI MD (OWNER)
- **Authorized official phone:** (219) 448-0369

## Contact information

- **Practice address:** 830 PARK EAST BLVD, LAFAYETTE, IN 47905-0778
- **Practice address phone:** (219) 448-0369
- **Mailing address:** 3679 WAKEFIELD DR, WEST LAFAYETTE, IN 47906-8708
- **Mailing address phone:** (219) 448-0369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2017
- **Last updated:** 02/14/2018