Individual
MAYANK KUMAR MITTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
610 N MICHIGAN ST STE 400, SOUTH BEND, IN 46601
(574) 647-8120
(574) 647-8111
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
T2009005450
MO
207RC0000X
Cardiovascular Disease Physician
01078863A
IN
207RC0000X
Cardiovascular Disease Physician
4301109220
MI
207RI0011X
Interventional Cardiology Physician
Primary
01078863A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300004379
—
IN
Enumeration date
07/01/2009
Last updated
04/28/2023
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