MEDICARE: DIPEN CHAMPAKLAL MAUN 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	208C00000X	Colon & Rectal Surgery Physician	01063299A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01063299A	OTHER	IN	PHYSICIAN LICENSE

General Provider Information

NPI Number	:	1154547420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIPEN CHAMPAKLAL MAUN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	1215 HADLEY RD STE 201
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2907
Country	:	US
Telephone Number	:	317-834-2020
Fax Number	:	317-831-9467

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/11/2023

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