Provider Demographics
NPI:1710068796
Name:OZOLS, INGRIDA IVETA (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRIDA
Middle Name:IVETA
Last Name:OZOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:INGRIDA
Other - Middle Name:IVETA
Other - Last Name:PERDUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6820 PARKDALE PLACE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6600
Mailing Address - Country:US
Mailing Address - Phone:317-329-7050
Mailing Address - Fax:317-328-6809
Practice Address - Street 1:6820 PARKDALE PLACE
Practice Address - Street 2:SUITE 211
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6600
Practice Address - Country:US
Practice Address - Phone:317-329-7050
Practice Address - Fax:317-328-6809
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027554207ND0900X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085209OtherANTHEM
INP00788064OtherRAILROAD MEDICARE
IN100334440Medicaid
INP00788064OtherRAILROAD MEDICARE
IN132590PPMedicare PIN
B28323Medicare UPIN