Organization
RAYMOND S NANKO MD
Active
Other names
ActiveCare Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND S NANKO MD (OWNER)
(765) 288-3276
Entity
Organization
Contact information
Practice address
919 W JACKSON ST, MUNCIE, IN 47305-1554
(765) 288-3276
(765) 289-2389
Mailing address
PO BOX 730, FISHERS, IN 46038-0730
(317) 219-5409
(317) 219-3151
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
01045371A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201163010 A
—
IN
Enumeration date
06/29/2012
Last updated
05/29/2015
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