Provider Demographics
NPI:1639120371
Name:HOVHANESSIAN, BANIPAL (MD)
Entity type:Individual
Prefix:
First Name:BANIPAL
Middle Name:
Last Name:HOVHANESSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2220 W ALTO RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-4840
Practice Address - Country:US
Practice Address - Phone:765-455-2577
Practice Address - Fax:765-455-0214
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100137220AMedicaid
INP01270971OtherRR MEDICARE
INB28795Medicare UPIN
IN1663038Medicare PIN
IN266180817Medicare PIN
IN365590AMedicare PIN