Individual
SUHIND KRISHNA DAS KODALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 676-4102
(812) 373-4106
Mailing address
6816 FORESTVIEW CT, WEST BLOOMFIELD, MI 48322-4506
(248) 660-6623
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01094293A
IN
208M00000X
Hospitalist Physician
4301509979
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540A23
MEDICARE PTAN
IN
01
—
1104289588
ANTHEM PTAN
IN
05
—
300094997
—
IN
Enumeration date
05/05/2021
Last updated
09/19/2024
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