Kollipara, Praveen

Kollipara, Praveen is an individual health care provider with primary practice located at 7910 W Jefferson Blvd Ste 108 , Fort Wayne IN 46804-4159. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as his primary health care specialty. Kollipara, Praveen can be contacted via phone (260) 484-8830.

Contact Information

Primary practice address
7910 W Jefferson Blvd Ste 108 Fort Wayne IN 46804-4159
Fax: (260) 483-1911
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 01046718A Indiana

Profile Details

NPI number 1073515987
LBN Legal business name Kollipara, Praveen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated May 6th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073515987 NPPES
Indiana Other 000000083727 ANTHEM
Indiana Other 000000693537 ANTHEM
Indiana MEDICAID 200148280 ANTHEM
Indiana MEDICAID 3045547 ANTHEM

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