Provider Demographics
NPI:1154391563
Name:PRESTO, EUGENE P (DO)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
Last Name:PRESTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 SOUTH DR
Practice Address - Street 2:FESLER HALL, RM 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5135
Practice Address - Country:US
Practice Address - Phone:317-274-0273
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36108988207L00000X
IN02002812207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200827420Medicaid
IL36108988Medicaid
IN200827420Medicaid
IL36108988Medicaid
ILK19931Medicare PIN