Individual
DR. PADMANABHA RAO BETINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., F.C.C.P.
Contact information
Practice address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(312) 479-8669
Mailing address
64619 ORCHARD DR, GOSHEN, IN 46526-9121
(574) 533-4003
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01039980
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089017
ANTHEM INSURANCE
IN
05
—
100114150
—
IN
Enumeration date
02/22/2006
Last updated
04/17/2012
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