Individual
SUDEEPTA A RAKHRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
303 S NAPPANEE ST, ELKHART, IN 46514-2066
(574) 296-3200
(574) 296-3921
Mailing address
PO BOX 2968, ELKHART, IN 46515-2968
(574) 296-3390
(574) 296-3391
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003431A
IN
207Q00000X
Family Medicine Physician
036112090
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112098
—
IL
05
—
200493650
—
IN
01
—
P00171780
R/R MEDICARE
—
01
—
P00713419
RR MEDICARE
IN
Enumeration date
09/19/2006
Last updated
06/28/2010
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