Individual
RAVISH J MAHAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 EXECUTIVE DR, SUITE B1, LAFAYETTE, IN 47905-4867
(765) 807-0531
(765) 807-0534
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01061610A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000390071
ANTHEM PROVIDER NUMBER
IN
05
—
200807890
—
IN
Enumeration date
08/19/2006
Last updated
03/04/2024
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