Individual
MRUTHYAMJAYA IVATURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 827-7703
Mailing address
PO BOX 1524, INDIANAPOLIS, IN 46206-1524
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
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