Individual
DR. VENKATESWARA R KANUBADDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 460-1383
Mailing address
1928 SYCAMORE HILLS DR, FORT WAYNE, IN 46814-9304
(260) 625-3540
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01028849A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082079
ANTHEM BC/BC
IN
05
—
100323110A
—
IN
Enumeration date
07/01/2005
Last updated
06/18/2013
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