Provider Demographics
NPI:1770585838
Name:CIULLA, THOMAS ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:CIULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10300 N ILLINOIS ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1168
Mailing Address - Country:US
Mailing Address - Phone:317-817-1822
Mailing Address - Fax:317-817-1898
Practice Address - Street 1:200 W 103RD ST
Practice Address - Street 2:SUITE 1050
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1017
Practice Address - Country:US
Practice Address - Phone:317-817-1822
Practice Address - Fax:317-817-1898
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045105A207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200374230DMedicaid
IN000000219802OtherANTHEM
IN38-2642669Other38-3642669
IN200374230CMedicaid
IN200374230BMedicaid
IN189520AMedicare PIN
IN000000219802OtherANTHEM