Provider Demographics
NPI:1700828050
Name:MEHDIRATTA, ATAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:ATAM
Middle Name:J
Last Name:MEHDIRATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL LN
Mailing Address - Street 2:STE 100
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 MERIDIAN ST STE 340
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4349
Practice Address - Country:US
Practice Address - Phone:765-646-8477
Practice Address - Fax:765-649-4290
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6762207RG0100X
IN01059560A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01678977OtherMEDICARE RR
IN200491100Medicaid
INP01678977OtherMEDICARE RR
IN257900B3Medicare PIN
IN266180646Medicare PIN