Provider Demographics
NPI:1437351095
Name:MANALOOR, JOHN JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JACOB
Last Name:MANALOOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:ROC 4380
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-7260
Practice Address - Fax:317-948-0860
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2012-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01066541A2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939320Medicaid
IN200939320Medicaid