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Individual

DR. RAVI K KODURU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1332 N 7TH ST, TERRE HAUTE, IN 47807-1004
(812) 478-8888
(812) 478-1114
Mailing address
264 E TRAILWOOD DR, TERRE HAUTE, IN 47802-9606
(812) 478-8888
(812) 478-1114

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01057643A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000299607
COMMERCIAL
IN
05
200456210
IN
01
P00057068
RR MEDICARE
IN
01
P01045883
RAILROAD MEDICARE
IN
Enumeration date
10/12/2006
Last updated
07/19/2012
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