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Contact Information

RAO V MANTRAVADI, MD
7910 W JEFFERSON BLVD STE 110
FORT WAYNE, IN46804-4159
 Phone: 260-436-4116
 Fax: 260-436-1878
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
Indicates primary specialty

NPI Profile & details for RAO V MANTRAVADI · (Male)

NPI # 1194726927
Status Active
Credentials MD
Entity Individual
Enumeration date 08/02/2005
Last updated 06/20/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01032697A
  • IN Medicaid 100321360
  • MI Medicaid 1194726927
  • OH Medicaid 0573026
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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