Provider Demographics
NPI:1992934020
Name:SARMA, HAVISHAKRISHNA (DO)
Entity type:Individual
Prefix:
First Name:HAVISHAKRISHNA
Middle Name:
Last Name:SARMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:HAVISH
Other - Middle Name:
Other - Last Name:SARMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2640 HAMSTROM RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-3832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2640 HAMSTROM RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3832
Practice Address - Country:US
Practice Address - Phone:219-762-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003960A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02003960AOtherSTATE LICENSE