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1639122047

NPI Code Detail

MEDICARE: PETRONIO ILAGAN MD

MEDICARE: PETRONIO ILAGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD425688	PA
2	2084N0400X	Neurology Physician	01030521A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	231420CC	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639122047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETRONIO ILAGAN MD

Provider Business Mailing Address
First Line	:	1040 SIERRA DR STE 400
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7241
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	3900 ST FRANCIS WAY STE 200
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4940
Country	:	US
Telephone Number	:	765-775-2800
Fax Number	:	765-775-2831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/07/2021

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Directions to “ PETRONIO ILAGAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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