MEDICARE: DR. ROGER ANDREW PIATEK M.D.

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	174400000X	Specialist	01036946	IN

General Provider Information

NPI Number	:	1902931926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER ANDREW PIATEK M.D.

Provider Business Mailing Address
First Line	:	745 BEACHWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-7700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 BEACHWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-7700
Country	:	US
Telephone Number	:	317-243-3000
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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