Individual
VIJAY G.T. KAMINENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N DETROIT ST, LAGRANGE, IN 46761-1158
(260) 463-2133
(260) 463-3775
Mailing address
PO BOX 236, LAGRANGE, IN 46761-0236
(260) 463-2133
(260) 463-3775
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01061449A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200821610
—
IN
Enumeration date
05/03/2006
Last updated
04/18/2024
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