Provider Demographics
NPI:1881955664
Name:KAUR, MANJIT (DPM)
Entity type:Individual
Prefix:
First Name:MANJIT
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SATORI PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6408
Mailing Address - Country:US
Mailing Address - Phone:317-456-9028
Mailing Address - Fax:317-386-5520
Practice Address - Street 1:301 SATORI PKWY STE 150
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6408
Practice Address - Country:US
Practice Address - Phone:317-456-9028
Practice Address - Fax:317-386-5520
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001209A213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265130034OtherMEDICARE
IN201300610Medicaid