Provider Demographics
NPI:1043417819
Name:PALERU, VIJAYASREE (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYASREE
Middle Name:
Last Name:PALERU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIJAYASREE
Other - Middle Name:
Other - Last Name:KUDITHIPUDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5330 E STOP 11 RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6345
Mailing Address - Country:US
Mailing Address - Phone:317-893-1900
Mailing Address - Fax:317-893-1685
Practice Address - Street 1:5330 E STOP 11 RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6345
Practice Address - Country:US
Practice Address - Phone:317-893-1900
Practice Address - Fax:317-893-1685
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068269A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease