Individual
BENERJI GUDAPATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
441 N WABASH, MARION, IN 46952-2612
(765) 660-6000
Mailing address
330 N WABASH, STE G20, MARION, IN 46952-2600
(765) 660-7600
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01061188A
IN
208M00000X
Hospitalist Physician
Primary
01061188A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001155405
ANTHEM
IN
05
—
200825710
—
IN
Enumeration date
05/27/2006
Last updated
10/13/2020
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