Organization
SPORTS & REGENERATIVE MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANISH MANNAN MD (OWNER)
(317) 660-2173
Entity
Organization
Contact information
Practice address
12188B N MERIDIAN ST, CARMEL, IN 46032-4840
(317) 660-2173
(317) 660-2393
Mailing address
PO BOX 80158, INDIANAPOLIS, IN 46280-0158
(317) 660-2173
(317) 660-2393
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01062145A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
PENDING
IN
Enumeration date
10/22/2012
Last updated
02/12/2013
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