Provider Demographics
NPI:1477756757
Name:THETHI, INDERPAL S (M D)
Entity Type:Individual
Prefix:
First Name:INDERPAL
Middle Name:S
Last Name:THETHI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4514
Practice Address - Street 1:1003 BELLEFONTAINE AVE STE 150
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1871
Practice Address - Country:US
Practice Address - Phone:419-998-8295
Practice Address - Fax:419-226-8323
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094974207RC0200X, 207RP1001X
TN57614207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.094974OtherOH MEDICAL LICENSE