Individual
ANANTACHOTE VIMUKTANANDANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
755 W WALNUT ST APT D, INDIANAPOLIS, IN 46202-3179
(317) 979-8409
Mailing address
755 W WALNUT ST APT D, INDIANAPOLIS, IN 46202-3179
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11013134A
IN
Other
Enumeration date
05/31/2008
Last updated
05/31/2008
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