Provider Demographics
NPI:1528160777
Name:AGRAWAL, VIVEK KUMAR (MD)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:KUMAR
Last Name:AGRAWAL
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 1:13345 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3318
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:
Practice Address - Street 1:13345 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3318
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2463272085R0202X
CAA984622085R0202X
IN01063473A2085R0202X
PAMD4445822085R0202X, 2085N0700X
TXM97782085R0202X
MO20060015692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1605144OtherGATEWAY
PA765419OtherUPMC
TX195353101Medicaid
PA2682453OtherHIGHMARK BLUE SHIELD
PA102672800Medicaid
IN300086932Medicaid
MD050546300Medicaid
PA30113205OtherAMERIHEALTH MERCY - WMG
PA234168FLTMedicare PIN
PA1605144OtherGATEWAY