Individual
PRAVEEN RAJANAHALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 E COUNTY LINE RD STE 210, GREENWOOD, IN 46143
(317) 300-7424
(317) 300-7976
Mailing address
701 E COUNTY LINE RD STE 210, GREENWOOD, IN 46143-1071
(317) 300-7424
(317) 300-7976
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
01067143A
IN
208D00000X
General Practice Physician
11013162A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200961530
—
IN
Enumeration date
03/05/2008
Last updated
04/01/2019
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