Provider Demographics
NPI:1427362508
Name:TEODOROVICH, NICHOLAY
Entity Type:Individual
Prefix:DR
First Name:NICHOLAY
Middle Name:
Last Name:TEODOROVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CAPITOL AVE
Mailing Address - Street 2:E 371
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1218
Mailing Address - Country:US
Mailing Address - Phone:317-962-0095
Mailing Address - Fax:317-962-0113
Practice Address - Street 1:1800 N CAPITOL AVE
Practice Address - Street 2:E 371
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1218
Practice Address - Country:US
Practice Address - Phone:317-962-0095
Practice Address - Fax:317-962-0113
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015512-A207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology