MEDICARE: DR. AMBAR BANERJEE 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	208600000X	Surgery Physician	01073596A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000865797	OTHER	IN	ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831339720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBAR BANERJEE M.D.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 CLEARVISTA DR STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4640
Country	:	US
Telephone Number	:	317-621-5673
Fax Number	:	317-621-6040

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

Provider Enumeration Date	:	03/04/2009
Last Update Date	:	07/25/2025

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