Provider Demographics
NPI:1467455931
Name:THOMASON, EILEEN BANGUIS (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:BANGUIS
Last Name:THOMASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-9312
Mailing Address - Fax:
Practice Address - Street 1:8711 US 31 S
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6252
Practice Address - Country:US
Practice Address - Phone:317-887-7771
Practice Address - Fax:317-497-2510
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043989A207Q00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200034480AMedicaid
INF87984Medicare UPIN