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Individual

KRUPA H DAVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
7120 CLEARVISTA DR, SUITE 2100, INDIANAPOLIS, IN 46256-1621
(317) 621-2740
(317) 621-5658
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001558A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P01261822
MEDICARE RR PTAN
IN
01
P01261824
MEDICARE RR PTAN
IN
Enumeration date
07/26/2013
Last updated
11/25/2014
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