Individual
DR. INDRAJEET MAHATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-3911
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-3911
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125060970
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
2020013458
MO
Other
Enumeration date
08/29/2012
Last updated
07/22/2020
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