Provider Demographics
NPI:1538116215
Name:INDUDHARA, RAMAIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAIAH
Middle Name:
Last Name:INDUDHARA
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 1:3311 E MURDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3054
Mailing Address - Country:US
Mailing Address - Phone:316-689-9185
Mailing Address - Fax:316-689-9909
Practice Address - Street 1:751 W LEGION RD STE 305
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7755
Practice Address - Country:US
Practice Address - Phone:760-351-4444
Practice Address - Fax:760-344-7106
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81435208800000X
KS04-37795208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200573670AMedicaid
CAA81435OtherCA LICENSE
CAG18611OtherSO CA MEDICARE PTAN
KS201107550AMedicaid
CAA81435OtherCA LICENSE