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1174789564

NPI Code Detail

MEDICARE: DR. AVINASH V MANTRAVADI MD

MEDICARE: DR. AVINASH V MANTRAVADI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	ME112145	FL
2	207Y00000X	Otolaryngology Physician	125053425	IL
3	207Y00000X	Otolaryngology Physician	01072985A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000836361	OTHER	IN	ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174789564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVINASH V MANTRAVADI MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-6057
Country	:	US
Telephone Number	:	317-865-6700
Fax Number	:	317-865-6707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	12/17/2020

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Directions to “ DR. AVINASH V MANTRAVADI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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