1013576784 NPI number — VARUN VANKA MD

Table of content: VARUN VANKA MD (NPI 1013576784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013576784 NPI number — VARUN VANKA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANKA
Provider First Name:
VARUN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013576784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 NE GLEN OAK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61637-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-387-1275
Provider Business Mailing Address Fax Number:
309-655-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 NORTH CAPITOL AVENUE
Provider Second Line Business Practice Location Address:
SUITE E371
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-387-1275
Provider Business Practice Location Address Fax Number:
346-387-1275
Provider Enumeration Date:
06/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X , with the licence number:  0109661B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 0109661B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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