Healthcare Provider Details

I. General information

NPI: 1891770707
Provider Name (Legal Business Name): SANJAY RAJNIKANT PARIKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 ST FRANCIS WAY STE 219
LAFAYETTE IN
47905-4917
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 833-890-5176
  • Fax: 765-428-5896
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number01037298A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number01037298
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01037298A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: