Individual
PREETHAM JETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 A MEDICAL ARTS BLVD, SUITE 105, ANDERSON, IN 46011-3437
(765) 298-4660
(765) 298-4926
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01040154A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000557249
ANTHEM
IN
01
—
000000586512
ANTHEM
IN
05
—
100120660
—
IN
01
—
4218217
AETNA
IN
01
—
P01214600
RR MEDICARE PTAN
IN
Enumeration date
04/27/2006
Last updated
06/11/2021
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