Provider Demographics
NPI:1487098141
Name:KATIPALLY, SWAPNA (MD)
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:KATIPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-0506
Mailing Address - Country:US
Mailing Address - Phone:765-298-4120
Mailing Address - Fax:765-751-3377
Practice Address - Street 1:3025 N OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2261
Practice Address - Country:US
Practice Address - Phone:765-298-4120
Practice Address - Fax:765-751-3377
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
57.022359390200000X
IN01074653A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200112430Medicaid