| Altus Direct, Llc | |
|
701 E County Line Rd Suite 210 Greenwood IN 46143-1072 | |
| (317) 300-7424 | |
| (317) 360-7976 |
| Full Name | Altus Direct, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 701 E County Line Rd, Greenwood, Indiana |
| Authorized Official Name and Position | Praveen Rajanahalli (TIN OWNER) |
| Authorized Official Contact | 3173007424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altus Direct, Llc 701 E County Line Rd Suite 210 Greenwood IN 46143-1072 Ph: (317) 300-7424 | Altus Direct, Llc 701 E County Line Rd Suite 210 Greenwood IN 46143-1072 Ph: (317) 300-7424 |
| NPI Number | 1750829230 |
|---|---|
| Provider Enumeration Date | 02/06/2017 |
| Last Update Date | 10/09/2023 |
| Certification Date | 10/09/2023 |
| Medicare PECOS PAC ID | 8921383605 |
|---|---|
| Medicare Enrollment ID | O20170320001957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750829230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Praveen Rajanahalli |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1497925572 PECOS PAC ID: 2365636669 Enrollment ID: I20101101000480 |
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