Provider Demographics
NPI:1992722797
Name:VENTRAPRAGADA, SHRIDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHRIDHAR
Middle Name:
Last Name:VENTRAPRAGADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 MAIN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3514
Mailing Address - Country:US
Mailing Address - Phone:219-836-9368
Mailing Address - Fax:219-836-9357
Practice Address - Street 1:2211 MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3514
Practice Address - Country:US
Practice Address - Phone:219-836-9368
Practice Address - Fax:219-836-9357
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062767207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200840380Medicaid
MA2142945Medicaid
MA2142945Medicaid
I43369Medicare UPIN