| NPI | 1750829230 |
|---|---|
| Doing Business As | SUPRO DIRECT |
| Entity Type | Organization |
| Authorized Contact | PRAVEEN RAJANAHALLI Tin Owner 317-300-7424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2023-10-09 |