Provider Demographics
NPI:1700261831
Name:INA UPRETY AGRAWAL
Entity Type:Organization
Organization Name:INA UPRETY AGRAWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INA
Authorized Official - Middle Name:UPRETY
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-969-5870
Mailing Address - Street 1:1614 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4323
Mailing Address - Country:US
Mailing Address - Phone:765-962-0823
Mailing Address - Fax:765-966-0773
Practice Address - Street 1:1614 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4323
Practice Address - Country:US
Practice Address - Phone:765-962-0823
Practice Address - Fax:765-966-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty