Provider Demographics
NPI:1043278039
Name:CHHEDA, MANISH N
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:N
Last Name:CHHEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD
Mailing Address - Street 2:STE.500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 N. UNIVERSITY BLVD.
Practice Address - Street 2:UH2007
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-2167
Practice Address - Fax:317-274-2305
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045343A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086823OtherANTHEM
IN200119040Medicaid
ING42146Medicare UPIN
IN000000086823OtherANTHEM