Healthcare Provider Details

I. General information

NPI: 1780035261
Provider Name (Legal Business Name): ROMESH GHANSHYAM DHADUK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 RONALD REAGAN PKWY STE 336
AVON IN
46123-6914
US

IV. Provider business mailing address

5471 GEORGETOWN RD STE C
INDIANAPOLIS IN
46254-5794
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-2311
  • Fax: 317-856-2313
Mailing address:
  • Phone: 317-297-0661
  • Fax: 317-328-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001307A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: