Provider Demographics
NPI:1881649176
Name:MOHINDRA, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:MOHINDRA
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 1:201 NORTH ILLINOIS ST
Mailing Address - Street 2:16TH FLOOR - SOUTH TOWER
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-4218
Mailing Address - Country:US
Mailing Address - Phone:765-446-4819
Mailing Address - Fax:765-446-4859
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-446-4819
Practice Address - Fax:765-446-4859
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060957A2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200542580Medicaid
IN000000520644OtherANTHEM
INP00414277OtherMEDICARE RAILROAD
IN222030SMedicare ID - Type Unspecified
IN200542580Medicaid
IN248640GMedicare PIN