Organization
JETTY HEART CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREETHAM JETTY MD (OWNER)
(765) 298-4422
Entity
Organization
Contact information
Practice address
1210 B MEDICAL ARTS BOULEVARD, SUITE 217, ANDERSON, IN 46011-3439
(765) 298-4422
(765) 298-4926
Mailing address
1210 B MEDICAL ARTS BOULEVARD, SUITE 217, ANDERSON, IN 46011-3439
(765) 298-4422
(765) 298-4926
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01040154A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200886890
—
IN
Enumeration date
01/29/2008
Last updated
10/23/2008
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