Provider Demographics
NPI:1053209833
Name:AVILES, EDUARDO ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ALFREDO
Last Name:AVILES
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 1:350 W 14TH ST FL HA7
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2369
Mailing Address - Country:US
Mailing Address - Phone:317-278-2682
Mailing Address - Fax:
Practice Address - Street 1:350 W 14TH ST FL HA7
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2369
Practice Address - Country:US
Practice Address - Phone:317-278-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11024528A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program