Basic Information
| Provider Information | |||||||||
| NPI: | 1821229329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FU | ||||||||
| FirstName: | PING | ||||||||
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| Credential: | MD., PH.D | ||||||||
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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: | 1111 RONALD REAGAN PKWY | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461237085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175774200 | ||||||||
| FaxNumber: | 3175779503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2009 | ||||||||
| LastUpdateDate: | 10/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | 01080339A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207L00000X | 01080339A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 006117 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 300013602 | 05 | IN | MEDICAID | 264430E10 | 01 | MEDICARE | OTHER | 000001168726 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER | 815500262 | 01 | IN | MEDICARE | OTHER |