Provider Demographics
NPI:1922005289
Name:UNFRIED, ANGELA KAYE (PA C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:UNFRIED
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:317-355-7220
Practice Address - Fax:317-355-9672
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000709A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01261837OtherMEDICARE RR PTAN
IN201100470Medicaid
INQ38188Medicare UPIN
IN264430063Medicare PIN
IN266180273Medicare PIN
INM400048855Medicare PIN