Individual
EILEEN BANGUIS THOMASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8711 US 31 S, INDIANAPOLIS, IN 46227-6252
(317) 887-7771
(317) 497-2510
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-9312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01043989A
IN
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
01043989A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200034480A
—
IN
Enumeration date
05/27/2005
Last updated
11/27/2023
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