Provider Demographics
NPI:1649845009
Name:INDURTI, NAGENDRA BABU (MBBS)
Entity type:Individual
Prefix:
First Name:NAGENDRA BABU
Middle Name:
Last Name:INDURTI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4373
Mailing Address - Country:US
Mailing Address - Phone:225-246-9790
Mailing Address - Fax:225-246-9160
Practice Address - Street 1:BATON ROUGE GENERAL MID-CITY, MEDICINE CLINIC,
Practice Address - Street 2:3401 NORTH BOULEVARD, SUITE 130
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-387-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2024-05-16
Deactivation Date:2022-11-25
Deactivation Code:
Reactivation Date:2022-11-30
Provider Licenses
StateLicense IDTaxonomies
LA341382207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program