Provider Demographics
NPI:1427079672
Name:ASAMOAH, ERNEST (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:ASAMOAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8435 CLEARVISTA PLACE
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-621-1006
Practice Address - Fax:317-621-1010
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050302A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000700857OtherANTHEM
IN200216260Medicaid
INP00096964OtherRR MEDICARE
INP00957593OtherRAILROAD MEDICARE
IN000000313246OtherANTHEM
IN213800BMedicare PIN
IN000000313246OtherANTHEM
INH06310Medicare UPIN