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ANNALIESA FANGUY MD
NPI 1760365530
Student in an Organized Health Care Education/Training Program in Mishawaka, IN

Active since July 29, 2025PECOS Enrolled
611 E DOUGLAS RD STE 407, MISHAWAKA, IN 46545(574) 335-6500 Get Directions Write a Review

NPPES record last updated: June 2, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 2, 2026, Apr 6, 2026 (2 updates tracked since 2026).

About Annaliesa Fanguy Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANNALIESA FANGUY MD (NPI 1760365530) is an individual student in an organized health care education/training program in Mishawaka, Indiana, licensed in Louisiana (348260) and active in the NPI registry since July 2025. She is enrolled in Medicare PECOS and is a graduate of Louisiana State University School Of Medicine In Shreveport (2025).

NPPES Registry Identity

NPI1760365530
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameANNALIESA FANGUYCredential: MD
Location Address611 E DOUGLAS RD STE 407Mishawaka, IN 46545-1468
Mailing Address611 E Douglas Rd Ste 407Mishawaka, IN 46545-1468 · (574) 335-6500
Phone(574) 335-6500
Sole ProprietorYes
Medical School CMSLouisiana State University School Of Medicine In ShreveportGraduated 2025
Enumeration DateJuly 29, 2025
Last NPPES UpdateJune 2, 20262 updates tracked since enumeration
NPPES CertifiedJune 2, 2026
✔ NPI 1760365530 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in LA · 348260
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
611 E DOUGLAS RD STE 407, Mishawaka, IN 46545
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Annaliesa Fanguy Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7113423229
PECOS Enrollment IDI20250929001979
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ALLYSON BRIANNE BRUNET SLUSSER DO
Student in an Organized Health Care Education/Training Program
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500
MIRANDA MACFARLANE PHARMD
Pharmacist
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-5000
PETER CARL CHRISTIAN BECK MD
Student in an Organized Health Care Education/Training Program
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500
JOSEPH ALAN STOLDT PHARMD
Pharmacist (Pharmacotherapy)
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500
ANNIE WU DO
Student in an Organized Health Care Education/Training Program
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500
AMELLE CHRISTINE ALDURRA DO
Student in an Organized Health Care Education/Training Program
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500
MIA LAMBERT MD
Student in an Organized Health Care Education/Training Program
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500
THOMAS WAITES DO
Student in an Organized Health Care Education/Training Program
611 E DOUGLAS RD STE 407
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Annaliesa Fanguy's NPI number?

The NPI number for Annaliesa Fanguy is 1760365530. It was assigned to this individual provider in the NPPES registry on July 29, 2025.

Where is Annaliesa Fanguy located?

Annaliesa Fanguy practices at 611 E Douglas Rd Ste 407, Mishawaka, IN 46545. The listed phone number is (574) 335-6500.

What is Annaliesa Fanguy's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Annaliesa Fanguy enrolled in Medicare?

Yes. Annaliesa Fanguy is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Annaliesa Fanguy was last updated on June 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.