Basic Information
| Provider Information | |||||||||
| NPI: | 1538116215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INDUDHARA | ||||||||
| FirstName: | RAMAIAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3311 E MURDOCK ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166899185 | ||||||||
| FaxNumber: | 3166899909 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 W LEGION RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | BRAWLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922277755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603514444 | ||||||||
| FaxNumber: | 7603447106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 208800000X | A81435 | CA | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 04-37795 | KS | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 200573670A | 05 | OK | MEDICAID | A81435 | 01 | CA | CA LICENSE | OTHER | G18611 | 01 | CA | SO CA MEDICARE PTAN | OTHER | 201107550A | 05 | KS | MEDICAID |