Provider Demographics
NPI:1861445918
Name:HEARTLAND NEUROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:HEARTLAND NEUROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-249-0990
Mailing Address - Street 1:1185 W CARMEL DR
Mailing Address - Street 2:STE D-3
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8708
Mailing Address - Country:US
Mailing Address - Phone:317-249-0990
Mailing Address - Fax:317-249-0999
Practice Address - Street 1:1185 W CARMEL DR
Practice Address - Street 2:STE D-3
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8708
Practice Address - Country:US
Practice Address - Phone:317-249-0990
Practice Address - Fax:317-249-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200088510AMedicaid
IN12948050OtherDEPT OF LABOR
I021587OtherCHAMPUS
INCC3453OtherRR MEDICARE
IN12948050OtherDEPT OF LABOR
IN200088510AMedicaid