Provider Demographics
NPI:1891866497
Name:TRIVEDI, MALAYKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:MALAYKUMAR
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MALAY
Other - Middle Name:
Other - Last Name:TRIVEDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:407 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1852
Mailing Address - Country:US
Mailing Address - Phone:765-362-4424
Mailing Address - Fax:765-364-4423
Practice Address - Street 1:407 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1852
Practice Address - Country:US
Practice Address - Phone:765-364-9720
Practice Address - Fax:765-364-9740
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032281A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093743OtherANTHEM ID#
IN100114830AMedicaid
IND69501Medicare UPIN
IN100114830AMedicaid