Organization
MIDWEST WELLNESS LLC
Active
Other names
MD Medical Weightloss and Wellness Centers
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVASU KESA MD (OWNER)
(317) 850-7725
Entity
Organization
Contact information
Practice address
6822 E 82ND ST STE 310, INDIANAPOLIS, IN 46250-1677
(317) 548-4666
(317) 350-0059
Mailing address
6822 E 82ND ST STE 310, INDIANAPOLIS, IN 46250-1677
(317) 548-4666
(317) 350-0059
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200389120
—
IN
Enumeration date
08/08/2015
Last updated
08/08/2015
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