| Diamond Medical Group | |
|
830 Park East Blvd Lafayette IN 47905-0778 | |
| (219) 448-0369 | |
| Not Available |
| Full Name | Diamond Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 830 Park East Blvd, Lafayette, Indiana |
| Authorized Official Name and Position | Benerji Gudapati (OWNER) |
| Authorized Official Contact | 2194480369 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Medical Group 3679 Wakefield Dr West Lafayette IN 47906-8708 Ph: (219) 448-0369 | Diamond Medical Group 830 Park East Blvd Lafayette IN 47905-0778 Ph: (219) 448-0369 |
| NPI Number | 1790297935 |
|---|---|
| Provider Enumeration Date | 10/27/2017 |
| Last Update Date | 02/14/2018 |
| Medicare PECOS PAC ID | 5799045688 |
|---|---|
| Medicare Enrollment ID | O20180214002816 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790297935 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Benerji Gudapati |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962459099 PECOS PAC ID: 5092712166 Enrollment ID: I20061102000288 |
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