Provider Demographics
NPI:1366448631
Name:MATURI, RAJ K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:K
Last Name:MATURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:
Other - Last Name:MATURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10300 N ILLINOIS STREET
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1167
Mailing Address - Country:US
Mailing Address - Phone:317-817-1414
Mailing Address - Fax:317-805-4587
Practice Address - Street 1:10300 N ILLINOIS ST STE 1060
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1167
Practice Address - Country:US
Practice Address - Phone:317-817-1414
Practice Address - Fax:317-805-4587
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050295207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5134 724OtherAETNA PROVIDER ID
IN000000196897OtherANTHEM BCBS PIN
IN352076654OtherTAX ID
IN180042424OtherRAILROAD MEDICARE PIN
IN200216230Medicaid
IN180042424OtherRAILROAD MEDICARE PIN
IN181140AMedicare PIN