Provider Demographics
NPI:1760739148
Name:BURLI, PRATIBHA RANGANATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIBHA
Middle Name:RANGANATHA
Last Name:BURLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 UNIVERSITY BLVD
Mailing Address - Street 2:UH2440
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-948-3026
Mailing Address - Fax:317-944-7417
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:UH2440
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-3026
Practice Address - Fax:317-944-7417
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072551A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201193910Medicaid
IN896330009Medicare PIN