Individual
DONATO CIACCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7950 N SHADELAND AVE, STE 350, INDIANAPOLIS, IN 46250
(317) 578-2600
(317) 578-6474
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01046365A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000793485
ANTHEM
IN
05
—
200085670
—
IN
05
—
200085670A
—
IN
01
—
P01170504
RR MEDICARE PTAN
IN
Enumeration date
03/18/2006
Last updated
11/27/2023
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