Provider Demographics
NPI:1780640664
Name:KIOVSKY, RICHARD DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEAN
Last Name:KIOVSKY
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:DEPARTMENT OF FAMILY MEDICINE, LO 260
Mailing Address - Street 2:1110 W. MICHIGAN STREET
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5102
Mailing Address - Country:US
Mailing Address - Phone:317-278-0310
Mailing Address - Fax:317-274-4444
Practice Address - Street 1:1 AMERICAN SQ STE 185
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46282-0003
Practice Address - Country:US
Practice Address - Phone:317-278-6161
Practice Address - Fax:317-638-0678
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027093A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine