Provider Demographics
NPI:1225079320
Name:INDIANA HEART ASSOCIATES PC
Entity Type:Organization
Organization Name:INDIANA HEART ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:YELETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-621-8666
Mailing Address - Street 1:8075 N SHADELAND AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2693
Mailing Address - Country:US
Mailing Address - Phone:317-621-8666
Mailing Address - Fax:317-621-8604
Practice Address - Street 1:521 E COUNTY LINE RD
Practice Address - Street 2:SUITE G
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1065
Practice Address - Country:US
Practice Address - Phone:317-887-7880
Practice Address - Fax:317-887-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003647A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2000201000AMedicaid
IN248520Medicare ID - Type Unspecified