Individual
SANJAY P TRIPATHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 334-5081
(812) 334-5091
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01094033A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01094033A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
04-32222
KS
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
54328
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540A30
MEDICARE PTAN
IN
05
—
300095094
—
IN
Enumeration date
05/27/2006
Last updated
10/03/2024
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