Individual
PREETHAM JETTY
Active
Individual
PREETHAM JETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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