Provider Demographics
NPI:1609850486
Name:BANGASH, SADAF (MD)
Entity Type:Individual
Prefix:
First Name:SADAF
Middle Name:
Last Name:BANGASH
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2572
Practice Address - Country:US
Practice Address - Phone:260-347-0977
Practice Address - Fax:260-347-8547
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060392A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200515640Medicaid
7911687OtherAETNA
IN17796OtherPHYSICIANS HEALTH PLAN
INP00226337OtherRAILROAD MEDICARE
IN000000570553OtherANTHEM
IN000000362585OtherANTHEM
IN3937240001OtherMEDICARE DMEPOS
I28445Medicare UPIN
IN069860QQQMedicare PIN
INP00226337OtherRAILROAD MEDICARE
7911687OtherAETNA