Individual
INDIRA MIRYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100
(608) 258-6259
Mailing address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100
(608) 258-6259
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
51803-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790951721
—
WI
Enumeration date
04/30/2008
Last updated
12/14/2020
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