Individual
SANJAY BASU NADESAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 353-9515
(812) 353-9275
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01089079A
IN
207P00000X
Emergency Medicine Physician
314926
NY
207P00000X
Emergency Medicine Physician
C1-0025743
DE
207P00000X
Emergency Medicine Physician
MD25906
ME
207R00000X
Internal Medicine Physician
01089079A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102791413
ANTHEM PTAN
IN
05
—
300073282
—
IN
Enumeration date
04/19/2017
Last updated
06/11/2026
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