Provider Demographics
NPI:1114978798
Name:AMIN, ANISHA ASHWIN (MD)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:ASHWIN
Last Name:AMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1141 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7205
Practice Address - Country:US
Practice Address - Phone:219-662-0700
Practice Address - Fax:219-662-0973
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054193A208000000X
OH35077875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000391410OtherBCBS
OH2647149Medicaid
IN000000721901OtherANTHEM TRADITIONAL
IN200333720Medicaid
IN000000721901OtherANTHEM TRADITIONAL
IN200333720Medicaid
000000391410OtherBCBS