Provider Demographics
NPI:1811949035
Name:GEETA, MANJEET (MD)
Entity type:Individual
Prefix:DR
First Name:MANJEET
Middle Name:
Last Name:GEETA
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 1:6375 US HIGHWAY 6 STE A
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5217
Mailing Address - Country:US
Mailing Address - Phone:219-762-3196
Mailing Address - Fax:
Practice Address - Street 1:6375 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5111
Practice Address - Country:US
Practice Address - Phone:219-762-3196
Practice Address - Fax:219-763-6438
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062217A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200823540Medicaid