Provider Demographics
NPI:1285977033
Name:NANAGAS, VIVIAN CRUZ (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:CRUZ
Last Name:NANAGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:502-429-6157
Practice Address - Street 1:4400 WESTON POINTE DR STE 150
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077
Practice Address - Country:US
Practice Address - Phone:317-732-4046
Practice Address - Fax:855-656-7325
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPENDING207K00000X
MI4301109337208000000X, 207K00000X, 207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program