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General NPI Number Information
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NPI Number | 1255794871
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Entity Type | Individual
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Provider Name | MAURO AMENDOLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 3000 S STATE ROAD 135 STE 310
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City | GREENWOOD
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State | IN
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Zip | 46143-5527
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Country | US
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Telephone | 317-497-2400
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Fax | 317-497-2515
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.138734
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01096178A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31446
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66230
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License Number State | TN
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