Provider Demographics
NPI:1760451413
Name:KAKANI, VIJAYA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:KAKANI
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:420 N 26TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2842
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7599
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061319A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11209994OtherCAQH NUMBER
IN000000380953OtherANTHEM PIN # / ARNETT
IN000000491790OtherANTHEM PIN # / OIGL
IN200539490Medicaid
INP00297795Medicare PIN
IN815540OMedicare PIN
IN815450AAMedicare PIN
IN000000491790OtherANTHEM PIN # / OIGL
IN000000380953OtherANTHEM PIN # / ARNETT
INP00264011Medicare PIN
IN142080LLLMedicare PIN
IN921480FFMedicare PIN