Individual
PRAVEEN KOLLIPARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7910 W JEFFERSON BLVD STE 108, FORT WAYNE, IN 46804-4159
(260) 484-8830
(260) 483-1911
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(855) 963-2100
(239) 236-2775
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
01046718A
IN
207RX0202X
Medical Oncology Physician
01046718A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083727
ANTHEM
IN
01
—
000000693537
ANTHEM
IN
05
—
200148280
—
IN
05
—
3045547
—
OH
Enumeration date
08/10/2005
Last updated
05/15/2025
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