MEDICARE: ANUPAMA MOHANRAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	01058220	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083679724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANUPAMA MOHANRAM M.D.

Provider Business Mailing Address
First Line	:	30 W RAMPART ST STE 200
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8846
Country	:	US
Telephone Number	:	317-421-2012
Fax Number	:	317-398-1851

Provider Business Practice Location Address
First Line	:	2451 INTELLIPLEX DR STE 210
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8581
Country	:	US
Telephone Number	:	317-421-2012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	01/07/2021

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Directions to “ ANUPAMA MOHANRAM M.D.” Practice Location

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