Provider Demographics
NPI:1316219819
Name:MURANAKA, AUSTIN ROY (DPM)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:ROY
Last Name:MURANAKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1228
Mailing Address - Country:US
Mailing Address - Phone:812-882-3312
Mailing Address - Fax:812-882-6181
Practice Address - Street 1:202 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1228
Practice Address - Country:US
Practice Address - Phone:812-882-3312
Practice Address - Fax:812-882-6181
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000233A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000772884OtherANTHEM
IN201076110Medicaid
IN201076110Medicaid