Individual
DR. RAVI KUDUMULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11115 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-6400
(260) 672-6459
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
43609
TN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01075277A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
43609
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q001555
—
TN
Enumeration date
05/02/2007
Last updated
01/04/2023
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