Provider Demographics
NPI:1770040602
Name:MIHANDA, AMOS MUKIZA
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:MUKIZA
Last Name:MIHANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 WISDOMS CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6725
Mailing Address - Country:US
Mailing Address - Phone:207-210-3605
Mailing Address - Fax:
Practice Address - Street 1:1800 N MERIDIAN ST STE 202A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1433
Practice Address - Country:US
Practice Address - Phone:317-340-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health