Individual
SANJU J DAFTARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11911 N MERIDIAN ST, SUITE 150, CARMEL, IN 46032-6904
(317) 621-6701
(317) 621-6707
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048910
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000230988
ANTHEM
IN
01
—
0801922004
RAILROAD MEDICARE
IN
Enumeration date
06/03/2006
Last updated
04/13/2017
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