Provider Demographics
NPI:1477537090
Name:MAKHECHA, SANJIV (DO)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:MAKHECHA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7432
Mailing Address - Country:US
Mailing Address - Phone:260-341-4540
Mailing Address - Fax:
Practice Address - Street 1:4799 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9225
Practice Address - Country:US
Practice Address - Phone:812-471-1591
Practice Address - Fax:812-471-6650
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002198A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000009672OtherENCORE
11100OtherPHP
IN000000195481OtherBCBS
OH2242666Medicaid
IN459320IMedicare ID - Type Unspecified
IN000000195481OtherBCBS