Provider Demographics
NPI:1114595394
Name:VEERULA, VIJAY (DO)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:VEERULA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 BROADWAY STE 350
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1412
Mailing Address - Country:US
Mailing Address - Phone:260-423-2675
Mailing Address - Fax:260-423-6621
Practice Address - Street 1:750 BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1412
Practice Address - Country:US
Practice Address - Phone:260-423-2675
Practice Address - Fax:260-423-6621
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11021688A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine