Healthcare Provider Details

I. General information

NPI: 1376642900
Provider Name (Legal Business Name): JULIAN Y UNGAR-SARGON M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S MCKINLEY AVE
RENSSELAER IN
47978-2949
US

IV. Provider business mailing address

123 S MCKINLEY AVE
RENSSELAER IN
47978-2949
US

V. Phone/Fax

Practice location:
  • Phone: 219-866-7222
  • Fax: 219-866-7001
Mailing address:
  • Phone: 219-866-7222
  • Fax: 219-866-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number336-077840
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01040129A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01040129A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: