Provider Demographics
NPI:1700815644
Name:KALLURI, KAMESWARI (MD)
Entity type:Individual
Prefix:DR
First Name:KAMESWARI
Middle Name:
Last Name:KALLURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 DON S POWERS DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4054
Mailing Address - Country:US
Mailing Address - Phone:219-836-8085
Mailing Address - Fax:219-836-8070
Practice Address - Street 1:10010 DON S POWERS DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4054
Practice Address - Country:US
Practice Address - Phone:219-836-8085
Practice Address - Fax:219-836-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200293690AMedicaid
IN167480Medicare PIN
ING64068Medicare UPIN