Basic Information
| Provider Information | |||||||||
| NPI: | 1992396337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY PHYSICIANS OF INDIANA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11911 N MERIDIAN ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460326904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176211006 | ||||||||
| FaxNumber: | 3176211010 | ||||||||
| Practice Location | |||||||||
| Address1: | 11911 N MERIDIAN ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460326904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176211006 | ||||||||
| FaxNumber: | 3176211010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | YELETI | ||||||||
| AuthorizedOfficialFirstName: | RAMARAO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF PHYSICIAN EXECUTIVE | ||||||||
| AuthorizedOfficialTelephone: | 3176219002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.