Provider Demographics
NPI:1093785701
Name:AGRAWAL, AMARNATH BADRIPRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AMARNATH
Middle Name:BADRIPRASAD
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 CATKIN CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9636
Mailing Address - Country:US
Mailing Address - Phone:219-395-8609
Mailing Address - Fax:219-395-8609
Practice Address - Street 1:1882 CATKIN CIR
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9636
Practice Address - Country:US
Practice Address - Phone:219-395-8609
Practice Address - Fax:219-395-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026072A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100163870Medicaid
IN217230MMMMedicare ID - Type Unspecified
IN100163870Medicaid