Individual
MRUTHYAMJAYA IVATURI
Active
Individual
MRUTHYAMJAYA IVATURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01035094A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079486
ANTHEM
IN
01
—
010021203
RAILROAD MEDICARE
—
05
—
100114890A
—
IN
01
—
1370988
UNITED MINE WORKERS
—
01
—
311255083
CHAMPUS
—
Enumeration date
02/05/2007
Last updated
09/25/2007
Update your record
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