Healthcare Provider Details

I. General information

NPI: 1801419130
Provider Name (Legal Business Name): JARRED R MONDONEDO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 365
INDIANAPOLIS IN
46237-0011
US

IV. Provider business mailing address

2650 WARRENVILLE RD STE 280
DOWNERS GROVE IL
60515-2075
US

V. Phone/Fax

Practice location:
  • Phone: 317-851-2331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01099178A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036.180154
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: