Provider Demographics
NPI:1538267281
Name:SINTSOV, DMITRIY R (MD)
Entity type:Individual
Prefix:
First Name:DMITRIY
Middle Name:R
Last Name:SINTSOV
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:765-448-8085
Practice Address - Street 1:600 MARY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747-2195
Practice Address - Country:US
Practice Address - Phone:812-450-2240
Practice Address - Fax:812-450-2710
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067281A207L00000X
ND9526207L00000X
MN61870207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000639273OtherANTHEM PROVIDER NUMBER
IN200974210Medicaid
NDI08234Medicare UPIN
IN815500CC7Medicare PIN
IN200974210Medicaid
ND13085Medicare ID - Type Unspecified
INP00843950Medicare PIN