| Sports & Regenerative Medicine Pc | |
|
12188b N Meridian St Carmel IN 46032-4840 | |
| (317) 660-2173 | |
| (317) 660-2393 |
| Full Name | Sports & Regenerative Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 12188b N Meridian St, Carmel, Indiana |
| Authorized Official Name and Position | Manish Mannan (OWNER) |
| Authorized Official Contact | 3176602173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sports & Regenerative Medicine Pc Po Box 80158 Indianapolis IN 46280-0158 Ph: (317) 660-2173 | Sports & Regenerative Medicine Pc 12188b N Meridian St Carmel IN 46032-4840 Ph: (317) 660-2173 |
| NPI Number | 1063765436 |
|---|---|
| Provider Enumeration Date | 10/22/2012 |
| Last Update Date | 02/12/2013 |
| Medicare PECOS PAC ID | 9638314800 |
|---|---|
| Medicare Enrollment ID | O20130320000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063765436 | NPI | - | NPPES |
| PENDING | Other | IN | PENDING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 01062145A (Indiana) | Primary |
| Provider Name | Manish Mannan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265461388 PECOS PAC ID: 0648270926 Enrollment ID: I20070110000582 |
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