Provider Demographics
NPI:1487651493
Name:ORFANOS, TRENT G (MD)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:G
Last Name:ORFANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3281
Mailing Address - Country:US
Mailing Address - Phone:219-663-4888
Mailing Address - Fax:219-663-4877
Practice Address - Street 1:300 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3281
Practice Address - Country:US
Practice Address - Phone:219-663-4888
Practice Address - Fax:219-663-4877
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027841A207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100259630AMedicaid
IND95558Medicare UPIN