Provider Demographics
NPI:1215995188
Name:MISUMI, CYNTHIA O (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:O
Last Name:MISUMI
Suffix:
Gender:
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 MARTIN LUTHER KING JR ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5019
Practice Address - Country:US
Practice Address - Phone:317-931-4300
Practice Address - Fax:317-931-4330
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01059250A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200493610Medicaid
IN200493610Medicaid
IN715530Y7Medicare PIN