Provider Demographics
NPI:1598737512
Name:GUNALE, SHIVAJI R (MD)
Entity Type:Individual
Prefix:
First Name:SHIVAJI
Middle Name:R
Last Name:GUNALE
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 1:115 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1310
Mailing Address - Country:US
Mailing Address - Phone:317-924-4022
Mailing Address - Fax:317-924-4233
Practice Address - Street 1:7229 CLEARVISTA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1698
Practice Address - Country:US
Practice Address - Phone:317-621-4300
Practice Address - Fax:317-621-4301
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026038A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000247011OtherANTHEM PIN (ICCC)
IN000000527371OtherANTHEM PIN (QOC)
IN100323770Medicaid
IN2107420OtherCIGNA PIN
IN000000489292OtherANTHEM PIN (CHOP)
IN4004226OtherAETNA PIN
IN217760EMedicare PIN
IN000000527371OtherANTHEM PIN (QOC)
IN4004226OtherAETNA PIN
IN248860DMedicare PIN
IN114620HHMedicare PIN