Individual
JOTHIHARAN MAHENTHIRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8075 N SHADELAND AVE, SUITE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-8500
(317) 621-8501
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01054396
IN
207RC0001X
Clinical Cardiac Electrophysiology Physician
01054396A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01054396A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200355740
—
IN
01
—
P01019183
RR MEDICARE PIN
IN
01
—
P01214701
RR MEDICARE PTAN
IN
Enumeration date
04/17/2006
Last updated
06/11/2021
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