Provider Demographics
NPI:1922362334
Name:RAYMOND S NANKO MD
Entity type:Organization
Organization Name:RAYMOND S NANKO MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:S
Authorized Official - Last Name:NANKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-288-3276
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-0730
Mailing Address - Country:US
Mailing Address - Phone:317-219-5409
Mailing Address - Fax:317-219-3151
Practice Address - Street 1:919 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1554
Practice Address - Country:US
Practice Address - Phone:765-288-3276
Practice Address - Fax:765-289-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045371A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201163010 AMedicaid
ING61644Medicare UPIN
IN466750Medicare PIN