Provider Demographics
NPI:1366545535
Name:JAI V. GHATNEKAR, MD
Entity type:Organization
Organization Name:JAI V. GHATNEKAR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAI
Authorized Official - Middle Name:V
Authorized Official - Last Name:GHATNEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-436-1900
Mailing Address - Street 1:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-802-3105
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:2001 STULTS RD
Practice Address - Street 2:STE 200
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-436-1900
Practice Address - Fax:260-436-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200890130Medicaid
176870Medicare PIN