Basic Information
| Provider Information | |||||||||
| NPI: | 1427079672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASAMOAH | ||||||||
| FirstName: | ERNEST | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8435 CLEARVISTA PLACE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176211006 | ||||||||
| FaxNumber: | 3176211010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 01050302A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 000000700857 | 01 | IN | ANTHEM | OTHER | 200216260 | 05 | IN | MEDICAID | P00096964 | 01 | IN | RR MEDICARE | OTHER | P00957593 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000313246 | 01 | IN | ANTHEM | OTHER |