Provider Demographics
NPI:1528385788
Name:SREEKANTH V INDURTI MD INC
Entity Type:Organization
Organization Name:SREEKANTH V INDURTI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:INDURTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-867-3985
Mailing Address - Street 1:PO BOX 8440
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0440
Mailing Address - Country:US
Mailing Address - Phone:419-885-0200
Mailing Address - Fax:419-885-0203
Practice Address - Street 1:218 FOREST GLEN DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8195
Practice Address - Country:US
Practice Address - Phone:419-885-0200
Practice Address - Fax:419-885-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0816412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2655309Medicaid
OH2655309Medicaid