Provider Demographics
NPI:1376850461
Name:AMMAKKANAVAR, NATRAJ REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:NATRAJ
Middle Name:REDDY
Last Name:AMMAKKANAVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-4300
Mailing Address - Fax:317-621-4301
Practice Address - Street 1:7979 N SHADELAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2042
Practice Address - Country:US
Practice Address - Phone:317-621-4300
Practice Address - Fax:317-621-4301
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070925A207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201125110Medicaid
IN000000943086OtherANTHEM
INP01751209OtherRR MEDICARE
INP01512377OtherRAILROAD MEDICARE
IN201125110Medicaid
IN000000943086OtherANTHEM