Provider Demographics
NPI:1942353362
Name:AESTHETIC PLASTIC SURGERY OF INDIANA
Entity Type:Organization
Organization Name:AESTHETIC PLASTIC SURGERY OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-848-5400
Mailing Address - Street 1:12188A N MERIDIAN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4578
Mailing Address - Country:US
Mailing Address - Phone:317-848-5400
Mailing Address - Fax:317-848-9314
Practice Address - Street 1:12188A N MERIDIAN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4578
Practice Address - Country:US
Practice Address - Phone:317-848-5400
Practice Address - Fax:317-848-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024839A208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084320OtherANTHEM BLUE CROSS BLUE SH
INE24667Medicare UPIN
IN000000084320OtherANTHEM BLUE CROSS BLUE SH