Provider Demographics
NPI:1093718579
Name:GRAYBILL, JIANAN (MD)
Entity Type:Individual
Prefix:
First Name:JIANAN
Middle Name:
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7229 CLEARVISTA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1698
Practice Address - Country:US
Practice Address - Phone:317-621-5656
Practice Address - Fax:317-621-4366
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040969A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100321780Medicaid
INP01157042OtherRR MEDICARE PTAN
INM400074742Medicare PIN
IN149720FMedicare PIN
IN100321780Medicaid
IN920005248Medicare PIN