Healthcare Provider Details

I. General information

NPI: 1740108950
Provider Name (Legal Business Name): RITVIK MISHRA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 N NOTRE DAME AVE
SOUTH BEND IN
46617-1404
US

IV. Provider business mailing address

425 VIBURNUM RUN
WESTFIELD IN
46074-8740
US

V. Phone/Fax

Practice location:
  • Phone: 574-631-5574
  • Fax:
Mailing address:
  • Phone: 317-922-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: