Individual
SHILPA RAVI MALLUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7120 CLEARVISTA DR, SUITE 2100, INDIANAPOLIS, IN 46256-1621
(317) 621-5676
(317) 621-5658
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01066431A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200963940
—
IN
01
—
P01133607
MEDICARE RAILROAD
IN
Enumeration date
05/29/2008
Last updated
10/24/2018
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