Provider Demographics
NPI:1720011778
Name:VEERISETTY, INDIRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:K
Last Name:VEERISETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PROFESSIONAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4113
Mailing Address - Country:US
Mailing Address - Phone:601-856-2460
Mailing Address - Fax:
Practice Address - Street 1:11 PROFESSIONAL PARKWAY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4113
Practice Address - Country:US
Practice Address - Phone:601-856-2460
Practice Address - Fax:601-856-4687
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDFEC CENTRALOtherGOVERNMENT W/C
MS00014170Medicaid
MS640881814OtherTAX IDENTIFICATION
MS1316128762OtherNPI
MS640881814OtherTAX IDENTIFICATION
MS110241834Medicare PIN
MS110000096Medicare PIN