Provider Demographics
NPI:1689088502
Name:KURUPPU, DULANJI
Entity Type:Individual
Prefix:
First Name:DULANJI
Middle Name:
Last Name:KURUPPU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 FIELDHURST LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7857
Mailing Address - Country:US
Mailing Address - Phone:317-450-8801
Mailing Address - Fax:
Practice Address - Street 1:340 W 10TH ST # 6200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3082
Practice Address - Country:US
Practice Address - Phone:317-274-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11017712A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program