Individual
DR. GANAPATHI GOTTUMUKKALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9660 WICKER AVE, SAINT JOHN, IN 46373-9487
(193) 651-1772
(219) 703-6662
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01086883A
IN
207Q00000X
Family Medicine Physician
036074987
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01625532
BLUE SHIELD PROVIDER #
IL
05
—
036074987
—
IL
05
—
300057653
—
IN
Enumeration date
07/19/2005
Last updated
09/03/2024
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