PETRUNGARO PLASTIC SURGERY LLC NPI 1639577794

NPI Information

NPI: 1639577794
Provider Name: PETRUNGARO PLASTIC SURGERY, LLC
Classification: Surgery - 2086S0122X
Entity Type: Organization

Specialization: Plastic and Reconstructive Surgery

Address:
800 MACARTHUR BLVD STE 21
MUNSTER, IN
ZIP 46321
Phone: (219) 836-1163
Get Directions

PETRUNGARO PLASTIC SURGERY, LLC is a plastic and reconstructive surgery surgery in Munster, IN. The provider is a surgeon who specializes in plastic and reconstructive surgery. PETRUNGARO PLASTIC SURGERY, LLC NPI is 1639577794. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

800 MACARTHUR BLVD STE 21
MUNSTER, IN
ZIP 46321-918
Phone: (219) 836-1163

The provider's authorized official is Jason M Petrungaro .
The authorized official title is President and has the following contact phone number (219) 836-1163.

The enumeration date for this NPI number is 12/5/2014 and was last updated on 5/8/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0122X	Surgery	Plastic and Reconstructive Surgery	01074460A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	914915	OTHER	INDIANA	BCBS
2	IN2244	MEDICARE PIN	INDIANA
3	9183790	OTHER	INDIANA	AETNA
4	5410211	OTHER	INDIANA	CIGNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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