Provider Demographics
NPI:1255794871
Name:AMENDOLA, MAURO (MD)
Entity type:Individual
Prefix:DR
First Name:MAURO
Middle Name:
Last Name:AMENDOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 S STATE ROAD 135 STE 310
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-5527
Practice Address - Country:US
Practice Address - Phone:317-497-2400
Practice Address - Fax:317-497-2515
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138734207Q00000X
IN01096178A207Q00000X
MS31446207Q00000X
390200000X
TN66230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program