Individual
REVATHY AMEERUDDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
24 JOLIET ST STE 101, DYER, IN 46311-1705
(219) 864-2059
(219) 864-2644
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
010-81500A
IN
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01061500A
IN
208100000X
Physical Medicine & Rehabilitation Physician
A84433
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A844330
—
CA
05
—
200943400
—
IN
Enumeration date
11/28/2006
Last updated
02/15/2023
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