Provider Demographics
NPI:1598700783
Name:PANNUNZIO, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:PANNUNZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13431 OLD MERIDIAN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7101
Mailing Address - Country:US
Mailing Address - Phone:317-249-2616
Mailing Address - Fax:317-249-2618
Practice Address - Street 1:13431 OLD MERIDIAN ST
Practice Address - Street 2:SUITE 225
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7101
Practice Address - Country:US
Practice Address - Phone:317-249-2616
Practice Address - Fax:317-249-2618
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01061807A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200814830Medicaid
IN200814830Medicaid
H16915Medicare UPIN