1508951641 NPI number — ANNETTE M DINNEEN MD

Table of content: ANNETTE M DINNEEN MD (NPI 1508951641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508951641 NPI number — ANNETTE M DINNEEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINNEEN
Provider First Name:
ANNETTE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508951641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8433 HARCOURT ROAD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-338-9393
Provider Business Mailing Address Fax Number:
317-338-9399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8433 HARCOURT ROAD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-338-9393
Provider Business Practice Location Address Fax Number:
317-338-9399
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  01042219 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000084544 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 258635 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351494388 . This is a "TRICARE NORTH REGION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "UNITED FOOD & COMM WORKER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "ELECTRICAL WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "BLUE CROSS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 024440 . This is a "SIHO SOUTHEASTERN IN HEAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 193523 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "ITT HARTFORD UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "IN COMPREHENSIVE HEALTH I" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "ICHIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00283868 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 430810 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000084544 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351494388 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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