Individual
NESHAHTHARI WIJEYAKUHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 N RITTER AVE STE 231, INDIANAPOLIS, IN 46219-3099
(317) 355-9290
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01075644A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
01075644A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010167
MEDICARE PTAN
IN
05
—
201332230
—
IN
Enumeration date
08/10/2010
Last updated
03/18/2024
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