# SPORTS & REGENERATIVE MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063765436
- **Authorized official:** MANISH MANNAN MD (OWNER)
- **Authorized official phone:** (317) 660-2173

## Contact information

- **Practice address:** 12188B N MERIDIAN ST, CARMEL, IN 46032-4840
- **Practice address phone:** (317) 660-2173
- **Practice address fax:** (317) 660-2393
- **Mailing address:** PO BOX 80158, INDIANAPOLIS, IN 46280-0158
- **Mailing address phone:** (317) 660-2173
- **Mailing address fax:** (317) 660-2393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 01062145A | IN | Yes |

## Other

- **Enumeration date:** 10/22/2012
- **Last updated:** 02/12/2013