Provider Demographics
NPI:1790960078
Name:SARDA, VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SARDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4881
Mailing Address - Fax:219-934-2478
Practice Address - Street 1:2434 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2942
Practice Address - Country:US
Practice Address - Phone:773-486-8820
Practice Address - Fax:773-486-8823
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-120446207RI0200X, 207R00000X
IN01066516A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01066516AOtherIN LICENSE NUMBER
IN200973440Medicaid
IN200973440BMedicaid
INM47140082OtherMEDICARE PTAN
IN261970038Medicare PIN
IN01066516AOtherIN LICENSE NUMBER