Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 01054396 | IN |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 01054396A | IN |
N | 207RC0200X | Critical Care Medicine | 01054396A | IN |
NPI | 1093779910 |
---|---|
Provider Name | Jothiharan Mahenthiran |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46250-2693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200355740 | (05) | IN |
G82839 | (02) | IN |
P01019183 | RR MEDICARE PIN (01) | IN |
P01214701 | RR MEDICARE PTAN (01) | IN |