Provider Demographics
NPI:1942224563
Name:RAMANA, DINDIGALLA V (MD)
Entity Type:Individual
Prefix:
First Name:DINDIGALLA
Middle Name:V
Last Name:RAMANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1352
Mailing Address - Country:US
Mailing Address - Phone:810-667-9390
Mailing Address - Fax:810-667-9341
Practice Address - Street 1:1500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1352
Practice Address - Country:US
Practice Address - Phone:810-667-9390
Practice Address - Fax:810-667-9341
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDR034635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1002080OtherMCLAREN HEALTH
A74160OtherHAP
340020639OtherRAILROAD MEDICARE
C1697OtherM-CARE
MI3404450902OtherBLUE CARE NETWORK
MI1099966Medicaid
3450902OtherHEALTH PLUS
340020639OtherRAILROAD MEDICARE
MI0445090Medicare PIN