Provider Demographics
NPI:1083177422
Name:KOLETTIS, GEORGE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROBERT
Last Name:KOLETTIS
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 1:720 ESKENAZI AVE, FOB 2ND FLOOR
Mailing Address - Street 2:ROOM F2-163
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1357
Mailing Address - Country:US
Mailing Address - Phone:317-278-5835
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE, FOB 2ND FLOOR
Practice Address - Street 2:ROOM F2-163
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1357
Practice Address - Country:US
Practice Address - Phone:317-278-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program