Provider Demographics
NPI:1285682054
Name:DHAR, SISIR K (MD)
Entity Type:Individual
Prefix:DR
First Name:SISIR
Middle Name:K
Last Name:DHAR
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 1:12256 WAYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9432
Mailing Address - Country:US
Mailing Address - Phone:317-288-3900
Mailing Address - Fax:
Practice Address - Street 1:12256 WAYSIDE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-9432
Practice Address - Country:US
Practice Address - Phone:317-288-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028487A207RN0300X
IN1028487A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100084330Medicaid
IL4950266012Medicaid
IN000000084501OtherANTHEM BLUE CROSS BLUE SH
IN855690BMedicare PIN
IND12754Medicare UPIN
IN000000084501OtherANTHEM BLUE CROSS BLUE SH