Provider Demographics
NPI:1881670545
Name:DUGAN, LAURA O (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:O
Last Name:DUGAN
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 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-328-5053
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-5050
Practice Address - Fax:317-328-4777
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038617A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN111287OtherHEALTH ALLIANCE
IN000000379709OtherANTHEM
IN067866OtherSIHO
IN005189OtherSIHO
IN071706OtherHEALTH ALLIANCE
IN100383780Medicaid
INQ0071707OtherCMO/SHO
IN000000379705OtherANTHEM
IN071706OtherHEALTH ALLIANCE
IN111287OtherHEALTH ALLIANCE