Provider Demographics
NPI:1396978540
Name:BERKOWITZ, SOLOMON I (CAA)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:I
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 PENNSYLVANIA PKWY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46280-1379
Practice Address - Country:US
Practice Address - Phone:317-577-4200
Practice Address - Fax:317-577-4200
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1911367H00000X
IN75000147A367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1100145426OtherANTHEM PTAN
IN300097010Medicaid
INQ00773302OtherRAILROAD PTAN