Healthcare Provider Details

I. General information

NPI: 1962401091
Provider Name (Legal Business Name): CYNTHIA LYNN PASCUAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 BITTERSWEET COMMONS BLVD W
GRANGER IN
46530-6959
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-8610
  • Fax: 574-271-8620
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301116513
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01054944A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: