Provider Demographics
NPI:1205047107
Name:MENSAH, ANTOINETTE A (MD)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:A
Last Name:MENSAH
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 1:1100 SOUTHFIELD DR STE 1370
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4300
Mailing Address - Country:US
Mailing Address - Phone:317-837-5566
Mailing Address - Fax:317-837-5567
Practice Address - Street 1:8244 E US HIGHWAY 36 STE 120
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9627
Practice Address - Country:US
Practice Address - Phone:317-456-9053
Practice Address - Fax:317-386-5480
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074188A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201232870Medicaid
IN201232870Medicaid
MO1205047107Medicaid
OKOKA102089Medicare PIN
IN201232870Medicaid
OK200339730AMedicaid
KS111075002Medicare PIN
IN151560071Medicare PIN