Provider Demographics
NPI:1902229784
Name:NAMANA, VINOD
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:NAMANA
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 1:10010 DON S POWERS DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4054
Mailing Address - Country:US
Mailing Address - Phone:219-934-4200
Mailing Address - Fax:219-922-5904
Practice Address - Street 1:10010 DON S POWERS DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4054
Practice Address - Country:US
Practice Address - Phone:219-934-4200
Practice Address - Fax:219-922-5904
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01080675A207RC0000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300017552Medicaid