Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01075832A | IN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 01075832A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0361.34392 | IL |
NPI | 1265729297 |
---|---|
Provider Name | Poonam Paruchuri |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201313360 | (05) | IN |