| Iu Health Medical Group, Llc | |
|
1701 N Senate Blvd Indianapolis IN 46202-1239 | |
| (317) 962-2000 | |
| Not Available |
| Full Name | Iu Health Medical Group, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1701 N Senate Blvd, Indianapolis, Indiana |
| Authorized Official Name and Position | David Burton (CHIEF REVENUE OFFICER) |
| Authorized Official Contact | 3179633349 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iu Health Medical Group, Llc 250 N Shadeland Ave Indianapolis IN 46219-4959 Ph: () - | Iu Health Medical Group, Llc 1701 N Senate Blvd Indianapolis IN 46202-1239 Ph: (317) 962-2000 |
| NPI Number | 1326893777 |
|---|---|
| Provider Enumeration Date | 04/19/2024 |
| Last Update Date | 07/12/2024 |
| Medicare PECOS PAC ID | 9638617913 |
|---|---|
| Medicare Enrollment ID | O20240817000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326893777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Minati D Swofford |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1346237476 PECOS PAC ID: 6305743220 Enrollment ID: I20040303000826 |
| Provider Name | Bruce H Matt |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1013941558 PECOS PAC ID: 2365338431 Enrollment ID: I20050125000821 |
| Provider Name | Alexander Zemtsov |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1811901184 PECOS PAC ID: 1759332570 Enrollment ID: I20050329000487 |
| Provider Name | Ginat W Mirowski |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1750380275 PECOS PAC ID: 3072540350 Enrollment ID: I20050720000148 |
| Provider Name | Stacey L Halum |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1275569592 PECOS PAC ID: 9133106248 Enrollment ID: I20060127000483 |
| Provider Name | Lawrence A Mark |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1720025372 PECOS PAC ID: 5597778423 Enrollment ID: I20060719000220 |
| Provider Name | Anita N Haggstrom |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1639288723 PECOS PAC ID: 3971579251 Enrollment ID: I20070112000199 |
| Provider Name | Marc L Frost |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1295733624 PECOS PAC ID: 3274638077 Enrollment ID: I20070424000508 |
| Provider Name | Laurie A Miranda |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1346269016 PECOS PAC ID: 6608942297 Enrollment ID: I20080905000055 |
| Provider Name | Rebecca J Trepcos-klinger |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1154535714 PECOS PAC ID: 4385637529 Enrollment ID: I20080905000065 |
| Provider Name | Michael G Moore |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1851427900 PECOS PAC ID: 0941392310 Enrollment ID: I20080908000204 |
| Provider Name | Abideen O Yekinni |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1710904164 PECOS PAC ID: 2668539743 Enrollment ID: I20090317000016 |
| Provider Name | Ingrida I Ozols |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1710068796 PECOS PAC ID: 4587711643 Enrollment ID: I20090408000089 |
| Provider Name | Alison S Klenk |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1205900800 PECOS PAC ID: 4082708474 Enrollment ID: I20090908000357 |
| Provider Name | Patricia A Treadwell |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1508892613 PECOS PAC ID: 3577696319 Enrollment ID: I20100730000856 |
| Provider Name | Charles W Yates |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1275709958 PECOS PAC ID: 7618001041 Enrollment ID: I20100819001139 |
| Provider Name | Taha Z Shipchandler |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1023288230 PECOS PAC ID: 7719037597 Enrollment ID: I20100827000030 |
| Provider Name | Elliot J Androphy |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1740261478 PECOS PAC ID: 0446297055 Enrollment ID: I20101007000142 |
| Provider Name | Christiane Machado |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1790925618 PECOS PAC ID: 9234308453 Enrollment ID: I20110804000426 |
| Provider Name | Rebecca M Risser |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1598909061 PECOS PAC ID: 1456510452 Enrollment ID: I20120312000250 |
| Provider Name | Matthew J Turner |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1033308275 PECOS PAC ID: 6204090145 Enrollment ID: I20120606000006 |
| Provider Name | Joanna Hwang Watkins |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1124079496 PECOS PAC ID: 3274681192 Enrollment ID: I20120720000016 |
| Provider Name | Jonathan Y Ting |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1609034651 PECOS PAC ID: 3274780820 Enrollment ID: I20120904000465 |
| Provider Name | Kristin E Hoffmann |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1710150214 PECOS PAC ID: 6507008216 Enrollment ID: I20130808000857 |
| Provider Name | Elizabeth Bryant |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1598914657 PECOS PAC ID: 6204076953 Enrollment ID: I20130927000262 |
| Provider Name | Melissa H Stanton |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1255676730 PECOS PAC ID: 0941435242 Enrollment ID: I20131022001268 |
| Provider Name | Jacqueline H Wylam |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1972946713 PECOS PAC ID: 4789819038 Enrollment ID: I20131023000420 |
| Provider Name | Avinash V Mantravadi |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1174789564 PECOS PAC ID: 3971768474 Enrollment ID: I20140113000495 |
| Provider Name | Steffanie A Standish |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1629401385 PECOS PAC ID: 1951531854 Enrollment ID: I20140219002110 |
| Provider Name | Noah P Parker |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1215100706 PECOS PAC ID: 7315175692 Enrollment ID: I20140602000644 |
| Provider Name | Nidhi Avashia-khemka |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1306145792 PECOS PAC ID: 1951527555 Enrollment ID: I20140716001765 |
| Provider Name | Rick F Nelson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1720287139 PECOS PAC ID: 9931333481 Enrollment ID: I20140821000320 |
| Provider Name | Diane N Turvy |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1952695744 PECOS PAC ID: 6406097278 Enrollment ID: I20150617001719 |
| Provider Name | Benjamin P Anthony |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1457666943 PECOS PAC ID: 5496076978 Enrollment ID: I20160713000716 |
| Provider Name | Katherine A Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396197950 PECOS PAC ID: 0143515924 Enrollment ID: I20160817002669 |
| Provider Name | Sahand Rahnama-moghadam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215257480 PECOS PAC ID: 9133415763 Enrollment ID: I20160908001271 |
| Provider Name | Elisa A Illing |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1851619845 PECOS PAC ID: 8921244609 Enrollment ID: I20160915000082 |
| Provider Name | Michael W Sim |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1730408493 PECOS PAC ID: 7719299528 Enrollment ID: I20160921000866 |
| Provider Name | Richard P Bassi |
|---|---|
| Provider Type | Practitioner - Anesthesiology Assistant |
| Provider Identifiers | NPI Number: 1508829409 PECOS PAC ID: 3072532696 Enrollment ID: I20161017000457 |
| Provider Name | Jessamyn R Ambler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881144715 PECOS PAC ID: 7517245988 Enrollment ID: I20161107000725 |
| Provider Name | Amanda S Weinzierl |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1801937248 PECOS PAC ID: 1557644465 Enrollment ID: I20170220000159 |
| Provider Name | Kathleen R Corbin |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1568479863 PECOS PAC ID: 1658654587 Enrollment ID: I20170220000530 |
| Provider Name | Lindsey K Shine |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1881018745 PECOS PAC ID: 2163793142 Enrollment ID: I20170809003158 |
| Provider Name | Rita R Patel |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1275598880 PECOS PAC ID: 5890061402 Enrollment ID: I20171026002562 |
| Provider Name | Nikolajs J Perdue |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1639580152 PECOS PAC ID: 6002031465 Enrollment ID: I20180810001481 |
| Provider Name | Syril Keena T Que |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1053672014 PECOS PAC ID: 0941502413 Enrollment ID: I20181211003461 |
| Provider Name | Jay Edward Wolverton |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1407291511 PECOS PAC ID: 2668692179 Enrollment ID: I20181228002471 |
| Provider Name | Kristen Suzanne Scheffel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194298752 PECOS PAC ID: 3476892019 Enrollment ID: I20190226003471 |
| Provider Name | Jenna L Streicher |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1619264660 PECOS PAC ID: 8820381627 Enrollment ID: I20190626003779 |
| Provider Name | Jessica Yesensky |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1043658818 PECOS PAC ID: 2264736255 Enrollment ID: I20190829000525 |
| Provider Name | Allison Rose Hammer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508191750 PECOS PAC ID: 1355584079 Enrollment ID: I20190829001282 |
| Provider Name | Dominic James Vernon |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1851737803 PECOS PAC ID: 5294976882 Enrollment ID: I20190829001372 |
| Provider Name | Tammy Jo Dukeshire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710441415 PECOS PAC ID: 0446581532 Enrollment ID: I20191003000907 |
| Provider Name | Kelly Lormore |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1851949820 PECOS PAC ID: 4082047022 Enrollment ID: I20191205002950 |
| Provider Name | Gabrielle Clark |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1568092559 PECOS PAC ID: 3779919717 Enrollment ID: I20200211000429 |
| Provider Name | Breeanna Wright |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1114576725 PECOS PAC ID: 2365872132 Enrollment ID: I20200417001949 |
| Provider Name | Keegan M Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538797212 PECOS PAC ID: 9638500986 Enrollment ID: I20200520003149 |
| Provider Name | Wenhua Chen |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1952795890 PECOS PAC ID: 2264862564 Enrollment ID: I20200521002063 |
| Provider Name | Emily P Ashby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518590504 PECOS PAC ID: 3173944535 Enrollment ID: I20200611000169 |
| Provider Name | Kathryn E Hull |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1720695752 PECOS PAC ID: 6406275981 Enrollment ID: I20201002000091 |
| Provider Name | Laura Katherine Durr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952900961 PECOS PAC ID: 7618389933 Enrollment ID: I20201210001077 |
| Provider Name | Baljit K Rehal |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1558696179 PECOS PAC ID: 5193131621 Enrollment ID: I20210309000980 |
| Provider Name | Stephanie Shapiro Wieczorek |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1992198527 PECOS PAC ID: 8729494166 Enrollment ID: I20210309001938 |
| Provider Name | Kevin R Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124791678 PECOS PAC ID: 8123423522 Enrollment ID: I20210824000508 |
| Provider Name | Satyan Sreenath |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1447638101 PECOS PAC ID: 7214240019 Enrollment ID: I20210825001310 |
| Provider Name | Janelle S Nassim |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1790212165 PECOS PAC ID: 9537431630 Enrollment ID: I20210825003113 |
| Provider Name | Lauren Sowa |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1811376593 PECOS PAC ID: 2163724733 Enrollment ID: I20210826000161 |
| Provider Name | Matthew Partain |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1174917280 PECOS PAC ID: 4587940986 Enrollment ID: I20210826002078 |
| Provider Name | Alhasan N Elghouche |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1235585878 PECOS PAC ID: 4284926726 Enrollment ID: I20210924000456 |
| Provider Name | Kelly Elizabeth Allison Foy |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1508412388 PECOS PAC ID: 3577957539 Enrollment ID: I20220308002317 |
| Provider Name | Vijay R Ramakrishnan |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1619014909 PECOS PAC ID: 4486704574 Enrollment ID: I20220504000246 |
| Provider Name | Madison Alexandra Plumer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790398824 PECOS PAC ID: 8921485673 Enrollment ID: I20220518001263 |
| Provider Name | Evan Charles Cumpston |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1376905877 PECOS PAC ID: 9133426711 Enrollment ID: I20220526002759 |
| Provider Name | Callie Brook Burgin |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1073019980 PECOS PAC ID: 7315201530 Enrollment ID: I20220725001524 |
| Provider Name | Edita Maria Newton |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1952807364 PECOS PAC ID: 9234487893 Enrollment ID: I20220808001038 |
| Provider Name | David A Campbell |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1518329697 PECOS PAC ID: 2062774342 Enrollment ID: I20220812000600 |
| Provider Name | Jenna M Westwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194450866 PECOS PAC ID: 6305221474 Enrollment ID: I20220912000254 |
| Provider Name | David Rosmarin |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1730353665 PECOS PAC ID: 7719031525 Enrollment ID: I20221118000836 |
| Provider Name | Michelle L Wagner-escobar |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1831464171 PECOS PAC ID: 9830568146 Enrollment ID: I20221208001477 |
| Provider Name | Tyler Nicholas Thomas |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1326602699 PECOS PAC ID: 1557694999 Enrollment ID: I20230608002054 |
| Provider Name | Janice Farlow |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1588010607 PECOS PAC ID: 9032487632 Enrollment ID: I20230731002061 |
| Provider Name | Catharina Daffre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023738242 PECOS PAC ID: 2769846807 Enrollment ID: I20230907004501 |
| Provider Name | Abena O Ofori |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1780727222 PECOS PAC ID: 9032211727 Enrollment ID: I20231205000695 |
| Provider Name | Sarah H Young |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1548654452 PECOS PAC ID: 3375879125 Enrollment ID: I20231222000999 |
| Provider Name | Mary Elizabeth Combs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821868787 PECOS PAC ID: 2668818667 Enrollment ID: I20240313001153 |
| Provider Name | Brittany Lynn Partain |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1851882906 PECOS PAC ID: 5496193070 Enrollment ID: I20240402000713 |
| Provider Name | Hunter Luke Elms |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1225590359 PECOS PAC ID: 7517308265 Enrollment ID: I20240511000412 |
| Provider Name | Hunter Davis Archibald |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1629531801 PECOS PAC ID: 7618304593 Enrollment ID: I20240513002290 |
| Provider Name | Benjamin Mark Wahle |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1689194243 PECOS PAC ID: 0143762526 Enrollment ID: I20240613000768 |
| Provider Name | Christine Li Barron |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1588125413 PECOS PAC ID: 2062955461 Enrollment ID: I20240613001846 |
| Provider Name | Noah Shaikh |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1932603529 PECOS PAC ID: 9436494184 Enrollment ID: I20240715003805 |
| Provider Name | Anne Marie Smith |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1639912587 PECOS PAC ID: 6709326465 Enrollment ID: I20240909001810 |
| Provider Name | Elham L Zayed |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1194450577 PECOS PAC ID: 3072984954 Enrollment ID: I20241018002546 |
| Provider Name | Shelby L Kubicki |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1043770746 PECOS PAC ID: 3577894245 Enrollment ID: I20241021001187 |
| Provider Name | Huynhvi Phan Nguyen |
|---|---|
| Provider Type | Practitioner - Anesthesiology Assistant |
| Provider Identifiers | NPI Number: 1649007899 PECOS PAC ID: 2163955501 Enrollment ID: I20241029003848 |
| Provider Name | Merritt M Peterson |
|---|---|
| Provider Type | Practitioner - Anesthesiology Assistant |
| Provider Identifiers | NPI Number: 1629895883 PECOS PAC ID: 9638603202 Enrollment ID: I20241106000415 |
| Provider Name | Mikiyas Fitawok |
|---|---|
| Provider Type | Practitioner - Anesthesiology Assistant |
| Provider Identifiers | NPI Number: 1447823075 PECOS PAC ID: 3274937230 Enrollment ID: I20241125001611 |
| Provider Name | Lindsey Bechtold |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1205582566 PECOS PAC ID: 0244765378 Enrollment ID: I20241126000467 |
| Provider Name | Yousef Al Ahwel |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093946576 PECOS PAC ID: 4385808609 Enrollment ID: I20241210001242 |
Moazzam Habib Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 9240 N Meridian St, Suite 240, Indianapolis, IN 46260 Phone: 317-571-0030 Fax: 317-571-0031 | |
Franciscan Health Indianapolis & Mooresville Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5230a East Stop 11 Road, Suite 250, Indianapolis, IN 46237 Phone: 317-528-8921 Fax: 317-528-6916 | |
Evernorth Care Providers - Delaware Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8888 Keystone Xing Ste 1300, Indianapolis, IN 46240 Phone: 773-292-4800 Fax: 312-564-4059 | |
Cadience Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5602 Caito Dr, Indianapolis, IN 46226 Phone: 901-235-2065 |