Provider Demographics
NPI:1922058684
Name:JUTHANI, SUNIL J (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:J
Last Name:JUTHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13100 E 136TH ST STE 3400
Practice Address - Street 2:IU SAXONY HOSPITAL
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9818
Practice Address - Country:US
Practice Address - Phone:317-678-3800
Practice Address - Fax:317-678-3830
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01041794A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100200310Medicaid
INF43440Medicare UPIN
INM400065783Medicare PIN
IN100200310Medicaid
IN715530TTMedicare PIN