Provider Demographics
NPI:1194781781
Name:KANAGY, SCOTT (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KANAGY
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 1:1201 S MAIN ST
Mailing Address - Street 2:DEPT: ED
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8481
Mailing Address - Country:US
Mailing Address - Phone:219-757-6310
Mailing Address - Fax:219-757-6312
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:DEPT: ED
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8481
Practice Address - Country:US
Practice Address - Phone:219-757-6310
Practice Address - Fax:219-757-6312
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001963A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200392360Medicaid
IN138200QMedicare PIN
INH06986Medicare UPIN