MEDICARE: MEERA MOHAN

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	163W00000X	Registered Nurse	041486343	IL
2	363LA2200X	Adult Health Nurse Practitioner	71014155A	IN

General Provider Information

NPI Number	:	1225726029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEERA MOHAN

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	701 SUPERIOR AVE STE 4100
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4037
Country	:	US
Telephone Number	:	219-934-4080
Fax Number	:	219-934-4075

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

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	01/01/2026

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Directions to “ MEERA MOHAN ” Practice Location

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