MEDICARE: SARANDA TILLMAN-KEYES

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	207Q00000X	Family Medicine Physician	71013644A	IN
2	207Q00000X	Family Medicine Physician	95036513	CA
3	363LF0000X	Family Nurse Practitioner	825642	NV
4	363LF0000X	Family Nurse Practitioner	APN.0104072-C-NP	CO
5	363L00000X	Nurse Practitioner	71013644A	IN
6	207Q00000X	Family Medicine Physician	APN.0104072-C-NP	CO
7	163W00000X	Registered Nurse	28217140C	IN
8	207Q00000X	Family Medicine Physician	10036573	OR
9	207Q00000X	Family Medicine Physician	AP61677188	WA
10	363L00000X	Nurse Practitioner	AP61677188	WA

General Provider Information

NPI Number	:	1174223788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARANDA TILLMAN-KEYES

Provider Business Mailing Address
First Line	:	220 VIRGINIA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3709
Country	:	US
Telephone Number	:	317-238-3534
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 VIRGINIA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3709
Country	:	US
Telephone Number	:	317-238-3534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	12/04/2025

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Directions to “ SARANDA TILLMAN-KEYES ” Practice Location

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