Individual
HAVISHAKRISHNA SARMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2640 HAMSTROM RD, PORTAGE, IN 46368-3832
(219) 762-9523
Mailing address
2640 HAMSTROM RD, PORTAGE, IN 46368-3832
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02003960A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02003960A
STATE LICENSE
IN
Enumeration date
07/10/2009
Last updated
05/30/2012
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