Provider Demographics
NPI:1871508507
Name:VYAS, DIPTI S (DO)
Entity Type:Individual
Prefix:
First Name:DIPTI
Middle Name:S
Last Name:VYAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 E COUNTY LINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1072
Mailing Address - Country:US
Mailing Address - Phone:317-885-2860
Mailing Address - Fax:317-885-2869
Practice Address - Street 1:701 E COUNTY LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1072
Practice Address - Country:US
Practice Address - Phone:317-885-2860
Practice Address - Fax:317-885-2869
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02002239A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200320630Medicaid
IN200320630Medicaid
INB32505Medicare UPIN
IN200320630Medicaid
IN000000312864OtherANTHEM