Individual
GEETA KARNIK MANTRAVADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.S.
Contact information
Practice address
1633 N CAPITOL AVE, INDIANAPOLIS, IN 46202-1261
(317) 962-0963
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01077366A
IN
207R00000X
Internal Medicine Physician
036.133163
IL
207R00000X
Internal Medicine Physician
MD038106
DC
207RI0200X
Infectious Disease Physician
Primary
01077366A
IN
207RI0200X
Infectious Disease Physician
36133163
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0361833163
MEDICAID
IL
01
—
206147
MEDICARE (GROUP PTAN)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP)
IL
01
—
F400102247
MEDICARE (INDIVIDUAL PTAN)
IL
01
—
P01253181
MEDICARE RAILROAD (INDIVIDUAL)
IL
Enumeration date
06/02/2008
Last updated
07/20/2022
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