Provider Demographics
NPI:1992770978
Name:PALLEKONDA, VINOD A (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:A
Last Name:PALLEKONDA
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 1:5340 WOBURN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2742
Mailing Address - Country:US
Mailing Address - Phone:317-331-3358
Mailing Address - Fax:
Practice Address - Street 1:9560 E 59TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1010
Practice Address - Country:US
Practice Address - Phone:317-621-1700
Practice Address - Fax:317-621-1711
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059054A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000344907OtherANTHEM
IN200930550Medicaid
IN200930550Medicaid
IN265900EMedicare PIN
INM400046101Medicare PIN
INI15658Medicare UPIN