Provider Demographics
NPI:1831103100
Name:INDIANA COSMETIC & PLASTIC SURGEONS, LLC
Entity Type:Organization
Organization Name:INDIANA COSMETIC & PLASTIC SURGEONS, LLC
Other - Org Name:CARMEL COSMETIC & PLASTIC SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRASEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-581-0001
Mailing Address - Street 1:PO BOX 34518
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-0518
Mailing Address - Country:US
Mailing Address - Phone:317-581-0001
Mailing Address - Fax:317-581-0002
Practice Address - Street 1:12425 OLD MERIDIAN ST
Practice Address - Street 2:SUITE #B1
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8724
Practice Address - Country:US
Practice Address - Phone:317-581-0001
Practice Address - Fax:317-581-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200830270AMedicaid