Provider Demographics
NPI:1164503538
Name:PUSCA, SORIN VLADIMIR (MD)
Entity Type:Individual
Prefix:
First Name:SORIN
Middle Name:VLADIMIR
Last Name:PUSCA
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2326 18TH ST
Practice Address - Street 2:STE 130
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5362
Practice Address - Country:US
Practice Address - Phone:812-334-5081
Practice Address - Fax:812-334-5091
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43140208G00000X
IN01070610A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201050240Medicaid
KY50024383OtherPASSPORT
KY7100085530Medicaid
KYP00742520OtherRAILROAD MEDICARE
KYC18008OtherCHI
KY000000626702OtherANTHEM
KY50024383OtherPASSPORT
KY000000626702OtherANTHEM
KY0736589Medicare PIN
KYC18008OtherCHI