Provider Demographics
NPI:1336133883
Name:ANGELICCHIO, LOUIS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOSEPH
Last Name:ANGELICCHIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-355-8326
Practice Address - Fax:317-621-4555
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01030336A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01134233OtherMEDICARE RAILROAD
IN000000764481OtherANTHME
IN200137580AMedicaid
IN000000764481OtherANTHME
INB29494Medicare UPIN
INB29494Medicare UPIN