MEDICARE: KEVIN MICHAEL JANDA JR. RD, CD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133V00000X	Registered Dietitian
2	133VN1005X	Renal Nutrition Registered Dietitian
3	133VN1006X	Metabolic Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1427365113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL JANDA JR. RD, CD

Provider Business Mailing Address
First Line	:	2140 N CAPITOL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1225
Country	:	US
Telephone Number	:	317-920-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 N CAPITOL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1225
Country	:	US
Telephone Number	:	317-920-3400
Fax Number	:

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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