Provider Demographics
NPI:1689697757
Name:PALLEKONDA, SUE (MD, MBBS)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:PALLEKONDA
Suffix:
Gender:F
Credentials:MD, MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 WOBURN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2742
Mailing Address - Country:US
Mailing Address - Phone:317-599-7681
Mailing Address - Fax:
Practice Address - Street 1:9820 E 141ST ST STE 100
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-9303
Practice Address - Country:US
Practice Address - Phone:317-794-2432
Practice Address - Fax:317-799-9669
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058024A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00249958OtherRR MEDICARE
IN000000329169OtherANTHEM
INP00249958OtherRR MEDICARE
INM400046126Medicare PIN
INH95601Medicare UPIN