Provider Demographics
NPI:1376757377
Name:SPRUNGER, ANDREW B (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:SPRUNGER
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 6B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1442
Practice Address - Country:US
Practice Address - Phone:317-621-1670
Practice Address - Fax:317-621-1680
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01063256A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200884250Medicaid
IN200884250Medicaid
INM400039753Medicare PIN
148310XMedicare PIN
INM400039755Medicare PIN
INM400046115Medicare PIN
INM400039750Medicare PIN
INM400039746Medicare PIN
823720QQQQMedicare PIN
IN827950O4Medicare PIN
INM400039760Medicare PIN