Provider Demographics
NPI:1417957457
Name:NAGUBADI, SUBBA RAO (MD)
Entity Type:Individual
Prefix:
First Name:SUBBA
Middle Name:RAO
Last Name:NAGUBADI
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 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-4004
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:1101 GLENDALE BLVD
Practice Address - Street 2:STE 111
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3767
Practice Address - Country:US
Practice Address - Phone:219-464-1001
Practice Address - Fax:219-465-7426
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032523A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100208510AMedicaid
IN192700AMedicare ID - Type Unspecified
B29266Medicare UPIN