Most Relevant Information
Provider Data
| NPI Number: | 1003074451 |
| Provider Name: | ANANTACHOTE VIMUKTANANDANA M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | 11013134A |
Most Important Dates
| Enumeration Date: | 05/31/2008 |
| Last Updated: | 05/31/2008 |
Provider Practice Location
755 W WALNUT ST APT D
INDIANAPOLIS
IN
462023179
Practice Location Phone/Fax
| Phone: | 3179798409 |
| Fax: |
Provider Mailing Location
755 W WALNUT ST APT D
INDIANAPOLIS
IN
462023179
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |