Provider Demographics
NPI:1366517971
Name:DEVNANI, RITA S (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:S
Last Name:DEVNANI
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 1:5502 E 16TH ST STE A12
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-4937
Mailing Address - Country:US
Mailing Address - Phone:317-355-2122
Mailing Address - Fax:317-351-7859
Practice Address - Street 1:5502 E 16TH ST STE A12
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-4937
Practice Address - Country:US
Practice Address - Phone:317-355-2122
Practice Address - Fax:317-351-7859
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01035871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100354970Medicaid
IN0000002261OtherANTHEM LEGACY
IN100354970Medicaid