Individual
MANGALORE JAIRAM SUBBARAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 E CULVER RD, SUITE 102, KNOX, IN 46534-2241
(574) 772-1580
(574) 772-1581
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01041718
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000682354
ANTHEM
IN
05
—
100383520
—
IN
Enumeration date
05/25/2006
Last updated
09/14/2021
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