Individual
DR. AVINASH V MANTRAVADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8820 S MERIDIAN ST, INDIANAPOLIS, IN 46217-6057
(317) 865-6700
(317) 865-6707
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01072985A
IN
207Y00000X
Otolaryngology Physician
125053425
IL
207Y00000X
Otolaryngology Physician
ME112145
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000836361
ANTHEM PIN
IN
05
—
201180760
—
IN
Enumeration date
08/05/2008
Last updated
12/17/2020
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