Individual
MITHUN MOHANA SHENOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DRIVE SUITE 320, FORT WAYNE, IN 46845
(260) 266-5300
(260) 266-5314
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
01079692A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015291
—
IN
Enumeration date
03/27/2013
Last updated
10/16/2024
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