Basic Information
Provider Information
NPI: 1366455412
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALLANOSA
FirstName: ARTURO
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2001 N GRANVILLE AVE
Address2:  
City: MUNCIE
State: IN
PostalCode: 473032110
CountryCode: US
TelephoneNumber: 7652840493
FaxNumber: 7652842434
Practice Location
Address1: 2015 JACKSON ST
Address2:  
City: ANDERSON
State: IN
PostalCode: 460164337
CountryCode: US
TelephoneNumber: 7656492511
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/13/2006
LastUpdateDate: 03/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X01026102AINY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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