Provider Demographics
NPI:1558859165
Name:GADDAM, ANURAG
Entity type:Individual
Prefix:MR
First Name:ANURAG
Middle Name:
Last Name:GADDAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CAPITOL AVE # E371
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1218
Mailing Address - Country:US
Mailing Address - Phone:317-274-0700
Mailing Address - Fax:
Practice Address - Street 1:1800 N CAPITOL AVE # E371
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5305
Practice Address - Country:US
Practice Address - Phone:317-274-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2025-08-04
Deactivation Date:2018-12-05
Deactivation Code:
Reactivation Date:2018-12-10
Provider Licenses
StateLicense IDTaxonomies
IN01096395A207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology