Provider Demographics
NPI:1790916799
Name:DORAIRAJ, KIRITHIKA (MD)
Entity Type:Individual
Prefix:
First Name:KIRITHIKA
Middle Name:
Last Name:DORAIRAJ
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 W MICHIGAN ST # CL365
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5209
Practice Address - Country:US
Practice Address - Phone:317-278-5099
Practice Address - Fax:317-274-2695
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055854207R00000X
KY47492207R00000X
IN01070951A207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY167499OtherSIHO - NIS
KY000000896588OtherANTHEM - NIS
KY50076562OtherPASSPORT - NIS
KY50076562OtherPASSPORT - NIS
INP01105034 RR MCMedicare PIN
KYK164550Medicare PIN
KY167499OtherSIHO - NIS