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Individual

KEERTHANA MOHANKUMAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1115 RONALD REAGAN PKWY STE 100, AVON, IN 46123-6913
(317) 217-2300
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01094409A
IN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1104323238
ANTHEM PTAN
IN
05
300094546
IN
Enumeration date
03/30/2019
Last updated
03/15/2025
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