Provider Demographics
NPI:1275537946
Name:SAYSANA, MICHELE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:SAYSANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:1633 N CAPITOL AVE
Practice Address - Street 2:STE 236
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-274-1201
Practice Address - Fax:317-278-9905
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ININ01053374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200389500Medicaid
KY64057706Medicaid
INH7736Medicare UPIN
KY64057706Medicaid