Provider Demographics
NPI:1487682167
Name:RAO, V DURGA MADHUSUDANA MURTHY (DO)
Entity Type:Individual
Prefix:DR
First Name:V DURGA MADHUSUDANA
Middle Name:MURTHY
Last Name:RAO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MADHU
Other - Middle Name:
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:615 FULMER RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-6911
Mailing Address - Country:US
Mailing Address - Phone:574-252-2663
Mailing Address - Fax:574-252-5940
Practice Address - Street 1:615 FULMER RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-6911
Practice Address - Country:US
Practice Address - Phone:574-252-2663
Practice Address - Fax:574-252-5940
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002522A207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2003865540Medicaid
INH75730Medicare UPIN
IN2003865540Medicaid