Provider Demographics
NPI:1265482988
Name:DODWANI, KISHIN K (MD)
Entity Type:Individual
Prefix:
First Name:KISHIN
Middle Name:K
Last Name:DODWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W UNIVERSITY AVE
Mailing Address - Street 2:RCS PROVIDER ENROLLMENT
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3428
Mailing Address - Country:US
Mailing Address - Phone:765-747-3111
Mailing Address - Fax:765-751-2757
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-587-4203
Practice Address - Fax:502-587-4155
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057137A207L00000X
KY38041207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64101058Medicaid
IN200448690AMedicaid
KYH86730Medicare UPIN
KY64101058Medicaid
IN200448690AMedicaid