Provider Demographics
NPI:1588780779
Name:DOSADO, AMBROSIO ARANAS (MD)
Entity type:Individual
Prefix:
First Name:AMBROSIO
Middle Name:ARANAS
Last Name:DOSADO
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 1:3048 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3470
Mailing Address - Country:US
Mailing Address - Phone:219-922-1581
Mailing Address - Fax:
Practice Address - Street 1:3847 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2332
Practice Address - Country:US
Practice Address - Phone:219-398-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044052A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000296072OtherBCBS
IN200057300Medicaid
IN184100Medicare ID - Type Unspecified
IN200057300Medicaid