Basic Information
| Provider Information | |||||||||
| NPI: | 1457523151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JULURI | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 N MERIDIAN ST | ||||||||
| Address2: | STE 500 PROVIDER ENROLLMENT | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462043908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179624946 | ||||||||
| FaxNumber: | 3179624950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 RONALD REAGAN PKWY | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461236911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172728050 | ||||||||
| FaxNumber: | 3172728051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 07/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 35.124233 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | 01063576A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200904700 | 05 | IN | MEDICAID |