Individual
MYTHILI GURRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
827 S GREEN RIVER RD, EVANSVILLE, IN 47715-4105
(812) 473-7225
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
01040824
IN
207K00000X
Allergy & Immunology Physician
36742
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100094590B
—
IN
Enumeration date
10/11/2006
Last updated
12/31/2020
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