Provider Demographics
NPI:1538328992
Name:MANTRAVADI, GEETA KARNIK (MD, MS)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:KARNIK
Last Name:MANTRAVADI
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:GEETA
Other - Middle Name:S
Other - Last Name:KARNIK
Other - Suffix:
Other - Last Name Type:Former Name
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 1:1633 N CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-962-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36133163207RI0200X
IN01077366A207RI0200X, 207R00000X
IL036.133163207R00000X
DCMD038106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361833163OtherMEDICAID
IL206147OtherMEDICARE (GROUP PTAN)
ILCA4748OtherMEDICARE RAILROAD (GROUP)
ILF400102247OtherMEDICARE (INDIVIDUAL PTAN)
ILP01253181OtherMEDICARE RAILROAD (INDIVIDUAL)