Provider Demographics
NPI:1316996259
Name:IGNACIO, CONNIE M (MD)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA CONCEPCION
Other - Middle Name:IGNACIO
Other - Last Name:NANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:441 N WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2612
Mailing Address - Country:US
Mailing Address - Phone:765-662-3320
Mailing Address - Fax:
Practice Address - Street 1:441 N WABASH AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2612
Practice Address - Country:US
Practice Address - Phone:765-662-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056978A207L00000X
IN01056978207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH63791Medicare UPIN
IN121540SMedicare Oscar/Certification