Provider Demographics
NPI:1932377090
Name:KANTAWALA, KARTIKEYA PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:KARTIKEYA
Middle Name:PRAKASH
Last Name:KANTAWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:714 N SENATE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3763
Mailing Address - Country:US
Mailing Address - Phone:317-715-6401
Mailing Address - Fax:317-715-6454
Practice Address - Street 1:714 N SENATE AVE
Practice Address - Street 2:STE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3763
Practice Address - Country:US
Practice Address - Phone:317-715-6401
Practice Address - Fax:317-715-6454
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20100266122085R0202X
IN01069498A2085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201029390Medicaid
IN201029390Medicaid