Healthcare Provider Details

I. General information

NPI: 1609295518
Provider Name (Legal Business Name): SUJAATA DWADASI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13914 SOUTHEASTERN PKWY STE 204
FISHERS IN
46037-7125
US

IV. Provider business mailing address

13914 SOUTHEASTERN PKWY STE 204
FISHERS IN
46037-7125
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-9277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number336103981
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01099137A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036142635
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberU0768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: