Organization
SURYA K NALLARI MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SURYA K NALLARI MD (PRESIDENT)
(219) 987-6010
Entity
Organization
Contact information
Practice address
404 10TH ST SW, DEMOTTE, IN 46310-9298
(219) 987-6010
Mailing address
404 10TH ST SW, DEMOTTE, IN 46310-9298
(219) 987-6010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01037891A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209586
ANTHEM
IN
05
—
201009800A
—
IN
05
—
201009800B
—
IN
05
—
201009800C
—
IN
Enumeration date
10/08/2010
Last updated
10/19/2011
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