Healthcare Provider Details

I. General information

NPI: 1588608863
Provider Name (Legal Business Name): TANMAY PANIGRAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 MCCARTY LN
LAFAYETTE IN
47905-8764
US

IV. Provider business mailing address

9743 WARWICK CT
MUNSTER IN
46321-3569
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-8000
  • Fax: 765-838-4758
Mailing address:
  • Phone: 219-775-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01060214A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01060214A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: