MEDICARE: CRISTINA SIMONA IVAN MD

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	2084N0400X	Neurology Physician	216619	MA
2	2084N0400X	Neurology Physician	01065170A	IN
3	2084V0102X	Vascular Neurology Physician	01065170A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	P00761824	OTHER	IN	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93367	OTHER	MA	FCHP
2	0035620	OTHER	MA	NHP
3	05-01246	OTHER	MA	EVERCARE
4	000000627778	OTHER	IN	ANTHEM PTAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	01Y008643MA01	OTHER	NH	ANTHEM
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	AA39276	OTHER	MA	HPHC
9	460281	OTHER	MA	THP
10	3981555	OTHER	MA	AETNA
11	J28937	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1932195732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA SIMONA IVAN MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:	317-963-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 WISHARD BLVD
Second Line	:	RG 6TH FLOOR
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2872
Country	:	US
Telephone Number	:	317-274-4455
Fax Number	:	317-278-4918

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/11/2025

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Directions to “ CRISTINA SIMONA IVAN MD” Practice Location

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