Basic Information
| Provider Information | |||||||||
| NPI: | 1265846554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVNANI | ||||||||
| FirstName: | TANYA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7250 CLEARVISTA DR STE 355 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462565609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176215676 | ||||||||
| FaxNumber: | 3176215678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2014 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2016029202 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2014016669 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35.131794 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 01082161A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 300026691 | 05 | IN | MEDICAID | P02258996 | 01 | IN | MEDICARE RR | OTHER |