Healthcare Provider Details

I. General information

NPI: 1710338611
Provider Name (Legal Business Name): NEELIMA GHANTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD STE 1B
INDIANAPOLIS IN
46260-1954
US

IV. Provider business mailing address

PO BOX 800
FRANKLIN IN
46131-0800
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7431
  • Fax:
Mailing address:
  • Phone: 317-736-3572
  • Fax: 317-736-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04483
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4377
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number02006787A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: