Provider Demographics
NPI:1629050539
Name:STUHLDREHER, PRATIMA V (MD)
Entity Type:Individual
Prefix:
First Name:PRATIMA
Middle Name:V
Last Name:STUHLDREHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRATIMA
Other - Middle Name:V
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH STRRET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR
Practice Address - Street 2:SUITE 4000
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1774
Practice Address - Country:US
Practice Address - Phone:317-577-7444
Practice Address - Fax:317-577-7433
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045048A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000647928OtherANTHEM
IN200089350Medicaid
IN266180DMedicare PIN
IN000000647928OtherANTHEM