Provider Demographics
NPI:1902806557
Name:KESHVANI, PYARALI M (MD)
Entity Type:Individual
Prefix:
First Name:PYARALI
Middle Name:M
Last Name:KESHVANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9660 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-923-2680
Mailing Address - Fax:219-923-4661
Practice Address - Street 1:8731 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1551
Practice Address - Country:US
Practice Address - Phone:219-923-2680
Practice Address - Fax:219-923-4661
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01045402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0091144786OtherBCBS OF ILLINOIS
IN200072000Medicaid
IN000000260208OtherANTHEM BCBS
INP00235597OtherMEDICARE RAILROAD
IN000000260208OtherANTHEM BCBS
IL0091144786OtherBCBS OF ILLINOIS