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General NPI Number Information
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NPI Number | 1881649176
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Entity Type | Individual
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Provider Name | SANJAY MOHINDRA MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1701 S CREASY LN
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City | LAFAYETTE
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State | IN
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Zip | 47905-4972
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Country | US
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Telephone | 765-446-4819
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Fax | 765-446-4859
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Provider Business Mailing Address
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Address Line | 201 NORTH ILLINOIS ST 16TH FLOOR - SOUTH TOWER
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-4218
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Country | US
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Telephone | 765-446-4819
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Fax | 765-446-4859
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01060957A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01060957A
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License Number State | IN
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