Provider Demographics
NPI:1164605580
Name:SANDHYA C DONEPUDI MD PC
Entity Type:Organization
Organization Name:SANDHYA C DONEPUDI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-663-3554
Mailing Address - Street 1:9128 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2907
Mailing Address - Country:US
Mailing Address - Phone:219-663-3554
Mailing Address - Fax:219-853-0594
Practice Address - Street 1:9128 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2907
Practice Address - Country:US
Practice Address - Phone:219-663-3554
Practice Address - Fax:219-853-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039622207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00174796OtherRAILROAD MEDICARE
IN000000342607OtherANTHEM
INF29309Medicare UPIN
IN219240Medicare PIN