Provider Demographics
NPI:1376642900
Name:UNGAR-SARGON, JULIAN Y (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:Y
Last Name:UNGAR-SARGON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2949
Mailing Address - Country:US
Mailing Address - Phone:219-866-7222
Mailing Address - Fax:219-866-7001
Practice Address - Street 1:123 S MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2949
Practice Address - Country:US
Practice Address - Phone:219-866-7222
Practice Address - Fax:219-866-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040129A2084N0400X, 208VP0014X
IL336-0778402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200210770AMedicaid
IN4513297OtherCIGNA
IN000000517639OtherANTHEM
IN213230AOtherUNITED HEALTHCARE
IN250490Medicare PIN
INP00476067Medicare PIN
IL216857Medicare PIN
INA67579Medicare UPIN