Provider Demographics
NPI:1902960966
Name:APURI, BHAKTAVATSALA RAO (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:BHAKTAVATSALA
Middle Name:RAO
Last Name:APURI
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 W JEFFERSON BLVD
Mailing Address - Street 2:STE 125
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6838
Mailing Address - Country:US
Mailing Address - Phone:260-434-1177
Mailing Address - Fax:260-434-1444
Practice Address - Street 1:4656 W JEFFERSON BLVD
Practice Address - Street 2:STE 125
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6838
Practice Address - Country:US
Practice Address - Phone:260-434-1177
Practice Address - Fax:260-434-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054665A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist