Individual
PRASANTHI TUMMURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1140 S CALUMET RD, CHESTERTON, IN 46304-3283
(219) 926-6717
Mailing address
814 LAPORTE AVE, VALPARAISO, IN 46383-5860
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01065776A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000600354
ANTHEM
IN
Enumeration date
12/11/2008
Last updated
05/29/2009
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