Provider Demographics
NPI:1700042868
Name:INDIRA ALLURU MD PC
Entity Type:Organization
Organization Name:INDIRA ALLURU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-695-1849
Mailing Address - Street 1:414 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1467
Mailing Address - Country:US
Mailing Address - Phone:810-695-1489
Mailing Address - Fax:810-695-1736
Practice Address - Street 1:414 PERRY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1467
Practice Address - Country:US
Practice Address - Phone:810-695-1849
Practice Address - Fax:810-695-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty