Provider Demographics
NPI:1861677361
Name:CORVERA, JOEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:S
Last Name:CORVERA
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 1:545 BARNHILL DR EH 215
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-948-0944
Mailing Address - Fax:317-274-2940
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-962-3256
Practice Address - Fax:317-274-2940
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 10154208G00000X
GA047725208G00000X
IN01066875208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000106900Medicaid
IN200947290Medicaid
IN200947290Medicaid
IN257700QMedicare PIN
INP01134255Medicare PIN
INP00804360Medicare PIN
AL127ZMedicare UPIN
INM400056758Medicare PIN