Organization
PORTER COUNTY ANESTHESIA ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJA RAVELLA M.D. (PRESIDENT)
(219) 983-5743
Entity
Organization
Contact information
Practice address
85 E US HIGHWAY 6, VALPARAISO, IN 46383-8947
(219) 983-5743
(219) 983-5994
Mailing address
PO BOX 10806, MERRILLVILLE, IN 46411-0806
(219) 983-5743
(219) 983-5994
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100208530 A-H
—
IN
01
—
DA4395
RR MEDICARE
IN
Enumeration date
06/01/2006
Last updated
03/18/2013
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