Provider Demographics
NPI:1447252309
Name:BISONO, SERGIO (MD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:BISONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SERGIO
Other - Middle Name:BISONO
Other - Last Name:CASTELLANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0249
Mailing Address - Country:US
Mailing Address - Phone:812-934-5974
Mailing Address - Fax:812-934-5974
Practice Address - Street 1:981 HIGHWAY 46 E
Practice Address - Street 2:SUITE E
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-7631
Practice Address - Country:US
Practice Address - Phone:812-934-5974
Practice Address - Fax:812-934-5974
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039757207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF01603Medicare UPIN
IN181210Medicare ID - Type Unspecified