Healthcare Provider Details

I. General information

NPI: 1326849589
Provider Name (Legal Business Name): ANDREW CVELBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 S MONROE MEDICAL PARK BLVD
BLOOMINGTON IN
47403-8000
US

IV. Provider business mailing address

3325 HILLCREST DR
COLUMBUS IN
47203-2611
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-1111
  • Fax:
Mailing address:
  • Phone: 812-343-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004886A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: