Provider Demographics
NPI:1225019813
Name:LABUS, THEODORE P (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:P
Last Name:LABUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-328-5053
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-5050
Practice Address - Fax:317-715-9965
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045335A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300109913OtherRR MEDICARE-352047427
IN000000082137OtherANTHEM-351158723
IN200224550Medicaid
IN000000492354OtherANTHEM 203778927
IN300109908OtherRR MEDCIARE-351158723
INQ0071506OtherCMOSHO351158723&352047427
IN005516OtherSIHO-351158723
IN061437OtherHEALTH ALLIANCE-351158723
INQ0071506OtherCMOSHO351158723&352047427
IN026010XXMedicare PIN