Provider Demographics
NPI:1891056164
Name:MAHARAJ-MIKIEL, INDIRA CASSANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:CASSANDRA
Last Name:MAHARAJ-MIKIEL
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 1:3347 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-1760
Mailing Address - Country:US
Mailing Address - Phone:325-208-3274
Mailing Address - Fax:325-208-3275
Practice Address - Street 1:3347 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-1760
Practice Address - Country:US
Practice Address - Phone:325-208-3274
Practice Address - Fax:325-208-3275
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09409100207Q00000X
TXQ9859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0423025Medicaid
TX337751701Medicaid
NJ394601Medicare PIN