Provider Demographics
NPI:1376798116
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:DR
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:YELETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-355-9777
Mailing Address - Street 1:920 N SHADELAND AVE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4898
Mailing Address - Country:US
Mailing Address - Phone:317-355-9783
Mailing Address - Fax:317-355-9760
Practice Address - Street 1:1159 W JEFFERSON ST
Practice Address - Street 2:SUITE 304/302
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2794
Practice Address - Country:US
Practice Address - Phone:317-736-7651
Practice Address - Fax:317-736-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-02-19
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
IN2000201000EMedicaid
IN2000201000EMedicaid
INCA1968Medicare PIN