Individual
CHANDANA VAVILALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10860 MAPLE LN, SAINT JOHN, IN 46373-8418
(219) 365-7000
(219) 365-2609
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01057596A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000072193
ANTHEM TRADITIONAL
IN
05
—
200496780
—
IN
Enumeration date
01/25/2006
Last updated
01/24/2025
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