Provider Demographics
NPI:1285836932
Name:MOTAGANAHALLI, RAGHUNANDAN LAKSHMANA
Entity Type:Individual
Prefix:DR
First Name:RAGHUNANDAN
Middle Name:LAKSHMANA
Last Name:MOTAGANAHALLI
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-355-6900
Practice Address - Fax:812-339-1292
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066089A208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN273010JOtherMEDICARE PTAN
IN815500267OtherMEDICARE PTAN
INP00806728OtherRAILROAD PTAN
IN200935200Medicaid