Healthcare Provider Details

I. General information

NPI: 1194789917
Provider Name (Legal Business Name): RATTANDEEP V JUNEJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-570-9556
  • Fax: 317-570-9556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01050810
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: