Provider Demographics
NPI:1609868801
Name:OLLO, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:OLLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 E STOP 11 RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6340
Mailing Address - Country:US
Mailing Address - Phone:317-528-4723
Mailing Address - Fax:317-528-4699
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6340
Practice Address - Country:US
Practice Address - Phone:317-528-4723
Practice Address - Fax:317-528-4699
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039941207X00000X
IN01039941A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093073OtherBLUE CROSS BLUE SHIELD
IN100118220AMedicaid
INF25899Medicare UPIN
IN382010DMedicare ID - Type Unspecified