Provider Demographics
NPI:1396025334
Name:DYSANGCO, ANDREW T (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:DYSANGCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130 - PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-274-7936
Mailing Address - Fax:317-274-1587
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-6953
Practice Address - Fax:317-944-1289
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2016-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
000000000000000390200000X
IN01074041A207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine