MEDICARE: UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	286500000X	Military Hospital	11017474A	IN
2	282N00000X	General Acute Care Hospital	11017474A	IN

General Provider Information

NPI Number	:	1073940664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES

Provider Business Mailing Address
First Line	:	430 INDIANA AVENUE
Second Line	:	APT 138
City	:	INDIANA
State	:	IN
Zip	:	46202-3275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 INDIANA AVE
Second Line	:	APT 138
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3275
Country	:	US
Telephone Number	:	791-920-0750
Fax Number	:

Authorized Official
Title or Position	:	PGY6
Name	:	DR. SHIVI S SIVA
Credential	:	MD
Telephone Number	:	317-671-3034

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	06/11/2016

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