MITTAPALLI, RAJA SEKAR (MD)

Provider Demographics

• NPI: 1275610271
• Name: MITTAPALLI, RAJA SEKAR (MD)
• Entity Type: Individual
• First Name: RAJA
• Middle Name: SEKAR
• Last Name: MITTAPALLI
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 6626 E 75TH ST STE 500
• Mailing Address - City: INDIANAPOLIS
• Mailing Address - State: IN
• Mailing Address - Zip Code: 46250-2890
• Mailing Address - Country: US
• Mailing Address - Phone: 317-621-1647
• Practice Address - Street 1: 1130 MEDICAL ARTS BLVD STE 250
• Practice Address - City: ANDERSON
• Practice Address - State: IN
• Practice Address - Zip Code: 46011-3431
• Practice Address - Country: US
• Practice Address - Phone: 765-298-4282
• Practice Address - Fax: 765-298-4989
• Is Sole Proprietor?: No
• Enumeration Date: 2006-11-01
• Last Update Date: 2023-12-08

Provider Licenses

State	License ID	Taxonomies
AZ	36264	207V00000X
IN	01079580A	207V00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	1063433720	Other	CLINIC NPI
	1245344316	Other	CLINIC NPI
	1962507376	Other	CLINIC NPI
AZ	183198	Medicaid
AZ	871450	Medicaid
	1043324932	Other	CLINIC NPI
IN	300009456	Medicaid
AZ	Z21115	Medicare PIN
	1043324932	Other	CLINIC NPI
AZ	871450	Medicaid
	031822	Medicare Oscar/Certification
	031824	Medicare Oscar/Certification
AZ	Z114584	Medicare PIN
	031823	Medicare Oscar/Certification
	031806	Medicare Oscar/Certification
AZ	Z21113	Medicare PIN
AZ	Z21130	Medicare PIN
	1063433720	Other	CLINIC NPI
	1962507376	Other	CLINIC NPI
AZ	183198	Medicaid