Individual
SANJAY MOHINDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 446-4819
(765) 446-4859
Mailing address
201 NORTH ILLINOIS ST, 16TH FLOOR - SOUTH TOWER, INDIANAPOLIS, IN 46204-4218
(765) 446-4819
(765) 446-4859
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01060957A
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01060957A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000520644
ANTHEM
IN
05
—
200542580
—
IN
01
—
P00414277
MEDICARE RAILROAD
IN
Enumeration date
05/24/2006
Last updated
03/17/2018
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