Individual
DR. RAGHUNANDAN LAKSHMANA MOTAGANAHALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 355-6900
(812) 339-1292
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01066089A
IN
2086S0129X
Vascular Surgery Physician
Primary
01066089A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200935200
—
IN
01
—
273010J
MEDICARE PTAN
IN
01
—
815500267
MEDICARE PTAN
IN
01
—
P00806728
RAILROAD PTAN
IN
Enumeration date
06/04/2007
Last updated
08/14/2023
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