Basic Information
| Provider Information | |||||||||
| NPI: | 1336378926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANDIONCO | ||||||||
| FirstName: | APRIL | ||||||||
| MiddleName: | ENESIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 DARLINGTON AVE. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CRAWFORSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479332060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653624940 | ||||||||
| FaxNumber: | 7653621302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11015150A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201086350 | 05 | IN | MEDICAID | M471400037 | 01 | IN | MEDICARE PROVIDER PTAN | OTHER |