Provider Demographics
NPI:1639154115
Name:AMIN, YOGESHCHANDRA M (MD)
Entity Type:Individual
Prefix:
First Name:YOGESHCHANDRA
Middle Name:M
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOGESH
Other - Middle Name:M
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1818 CAREW ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4788
Mailing Address - Country:US
Mailing Address - Phone:260-373-9250
Mailing Address - Fax:260-373-9262
Practice Address - Street 1:1818 CAREW STREET
Practice Address - Street 2:SUITE 260
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-373-9250
Practice Address - Fax:260-373-9262
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027975A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4047039OtherAETNA HEALTHCARE
00000916172 05OtherUNITED HEALTHCARE
IN100054040Medicaid
IN1027OtherPHYSICIANS HEALTH PLAN
IN000000111782OtherANTHEM
IN110175707OtherRAILROAD MEDICARE
IN3937240010OtherMEDICARE DMEPOS
00000916172 05OtherUNITED HEALTHCARE
IN4047039OtherAETNA HEALTHCARE
IN069860VVVMedicare PIN