Provider Demographics
NPI:1093784944
Name:DUNSEATH, RODNEY A (DO)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:DUNSEATH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2403 LOY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2701
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-4351
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002223A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN453587OtherPHCS PID NUMBER
IN000000181565OtherANTHEM PROVIDER NUMBER
IN10825031OtherCAQH NUMBER
IN200304740Medicaid
IN815500XXXMedicare PIN
IN000000181565OtherANTHEM PROVIDER NUMBER
INE02914Medicare UPIN
IN815520UUMedicare PIN
IN142080WWMedicare PIN
IN10825031OtherCAQH NUMBER
IN185510PPMedicare PIN
IN815510PPMedicare PIN