| Supro Direct | |
|
1040 Greenwood Springs Blvd Ste 1a Greenwood IN 46143 | |
| (317) 300-7424 | |
| (317) 360-6245 |
| Full Name | Supro Direct |
|---|---|
| Speciality | Family Medicine |
| Location | 1040 Greenwood Springs Blvd, Greenwood, Indiana |
| Authorized Official Name and Position | Praveen Rajanahalli (TIN OWNER) |
| Authorized Official Contact | 3173007424 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supro Direct 1040 Greenwood Springs Blvd Ste 1a Greenwood IN 46143 Ph: (317) 300-7424 | Supro Direct 1040 Greenwood Springs Blvd Ste 1a Greenwood IN 46143 Ph: (317) 300-7424 |
| NPI Number | 1750829230 |
|---|---|
| Provider Enumeration Date | 02/06/2017 |
| Last Update Date | 09/17/2026 |
| Certification Date | 09/17/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750829230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Secondary |
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