Provider Demographics
NPI:1336378926
Name:GANDIONCO, APRIL ENESIO (MD)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:ENESIO
Last Name:GANDIONCO
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 DARLINGTON AVE.
Practice Address - Street 2:SUITE 300
Practice Address - City:CRAWFORSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-2060
Practice Address - Country:US
Practice Address - Phone:765-362-4940
Practice Address - Fax:765-362-1302
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015150A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201086350Medicaid
INM471400037OtherMEDICARE PROVIDER PTAN