Basic Information
| Provider Information | |||||||||
| NPI: | 1619951837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARANGI | ||||||||
| FirstName: | SHAMIT | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2303 DEPT 163 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006344064 | ||||||||
| FaxNumber: | 9525136880 | ||||||||
| Practice Location | |||||||||
| Address1: | 11900 N PENNSYLVANIA STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460324694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178460717 | ||||||||
| FaxNumber: | 3178460557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME97159 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | ME97159 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 276805400 | 05 | FL | MEDICAID | P00387045 | 01 | FL | RR MEDICARE | OTHER | P00375617 | 01 | FL | RR MEDICARE | OTHER |