Provider Demographics
NPI:1003884404
Name:KESA, SRINIVASU (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASU
Middle Name:
Last Name:KESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KESA
Other - Middle Name:
Other - Last Name:SRINIVASU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3471 MUIRFIELD WAY
Mailing Address - Street 2:STE. 400
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9375
Mailing Address - Country:US
Mailing Address - Phone:317-850-7725
Mailing Address - Fax:
Practice Address - Street 1:3471 MUIRFIELD WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-850-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056280A208M00000X
IN01056280 A207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200389120Medicaid
IN200389120Medicaid
IN898190C2Medicare PIN