Healthcare Provider Details

I. General information

NPI: 1740437342
Provider Name (Legal Business Name): MANEESHA AHLUWALIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE STE 200C
EVANSVILLE IN
47714-0100
US

IV. Provider business mailing address

PO BOX 359
EVANSVILLE IN
47703-0359
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-1788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number250962
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01071594A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: