Provider Demographics
NPI:1528015344
Name:TUMULURI, VINAY C (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:C
Last Name:TUMULURI
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:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:7002 W JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-8289
Practice Address - Country:US
Practice Address - Phone:219-325-0604
Practice Address - Fax:219-879-1401
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058863208M00000X
IN01058863A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200505840Medicaid
IN000000489697OtherANTHEM. BCBS
IN200505840Medicaid
160170EMedicare ID - Type Unspecified
I19685Medicare UPIN
IN200505840Medicaid
IN940640HHHMedicare PIN