Provider Demographics
NPI:1932186723
Name:AGNIHOTRI, DINESH (MD)
Entity Type:Individual
Prefix:
First Name:DINESH
Middle Name:
Last Name:AGNIHOTRI
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-434-6407
Mailing Address - Fax:260-434-6395
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-434-6407
Practice Address - Fax:260-434-6395
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066328A207R00000X
IN01066328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200940170Medicaid
IN000000611564OtherANTHEM
IN7139672OtherAETNA
IN000000611564OtherANTHEM
TNH35520Medicare UPIN
TNH35520Medicare UPIN
IN260690SSSMedicare PIN