Individual
DR. SHIVA PRASAD GANGADHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6330 E 75TH ST, STE 110, INDIANAPOLIS, IN 46250-2777
(317) 588-7149
(317) 588-7150
Mailing address
6330 E 75TH ST STE 110, INDIANAPOLIS, IN 46250-2717
(317) 588-7130
(317) 588-7133
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01075188A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201109490
—
IN
Enumeration date
03/12/2012
Last updated
12/08/2020
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