Individual
DR. SANJAY MOHANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD STE 1295, INDIANAPOLIS, IN 46202-5149
(317) 944-0931
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01082407A
IN
208600000X
Surgery Physician
4301099184
MI
208C00000X
Colon & Rectal Surgery Physician
Primary
01082407A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
233690095
MEDICARE PTAN
IN
05
—
300027159
—
IN
Enumeration date
06/22/2011
Last updated
08/14/2023
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