Healthcare Provider Details

I. General information

NPI: 1154325959
Provider Name (Legal Business Name): MAHENDRA R. SANAPATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL BLVD STE 100
EVANSVILLE IN
47714-8016
US

IV. Provider business mailing address

1101 PROFESSIONAL BLVD STE 100
EVANSVILLE IN
47714-8018
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-7246
  • Fax: 812-477-7240
Mailing address:
  • Phone: 812-477-7246
  • Fax: 812-477-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0000059431
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number37465
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01055762A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: