Provider Demographics
NPI:1548218860
Name:CARRANZA, CARYN (MD)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:CARRANZA
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 1:901 MACARTHUR BLVD
Mailing Address - Street 2:ATTN ANESTHESIA
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:ATTN ANESTHESIA
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-513-1127
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058361A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000331671OtherANTHEM BCBS
IL036076383Medicaid
IN200186550AMedicaid
INE47094Medicare UPIN
IN148530YMedicare PIN