Provider Demographics
NPI:1134129885
Name:CARDIOTHORACIC ANESTHESIA OF INDIANA, PC
Entity Type:Organization
Organization Name:CARDIOTHORACIC ANESTHESIA OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STOGSDILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-802-6290
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT 18
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-802-6290
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:2001 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1902
Practice Address - Country:US
Practice Address - Phone:317-802-6290
Practice Address - Fax:317-870-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003431207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100120820AMedicaid
IN277840Medicare PIN