Provider Demographics
NPI:1780894642
Name:THEPJATRI, NATE (MD)
Entity type:Individual
Prefix:
First Name:NATE
Middle Name:
Last Name:THEPJATRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PARKWAY
Practice Address - Street 2:SUITE 290
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5604
Practice Address - Country:US
Practice Address - Phone:317-621-7780
Practice Address - Fax:317-621-7783
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063790A208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000528259OtherANTHEM
IN200870520Medicaid
INP01105845OtherMEDICARE RAILROAD
IN000000780870OtherANTHEM
IN7695933OtherAETNA
IN000000609664OtherANTHEM
IN252240CMedicare PIN
IN260640DMedicare PIN
IN200870520Medicaid