Provider Demographics
NPI:1700022746
Name:PAGADUAN, DAVID NICK
Entity Type:Individual
Prefix:
First Name:DAVID NICK
Middle Name:
Last Name:PAGADUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 W 71ST ST
Mailing Address - Street 2:STE 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2711
Mailing Address - Country:US
Mailing Address - Phone:317-388-0800
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:5980 W 71ST ST
Practice Address - Street 2:STE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2711
Practice Address - Country:US
Practice Address - Phone:317-388-0800
Practice Address - Fax:317-388-0805
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008095171W00000X
NY030946171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor