Healthcare Provider Details

I. General information

NPI: 1831103100
Provider Name (Legal Business Name): INDIANA COSMETIC & PLASTIC SURGEONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 OLD MERIDIAN ST SUITE #B1
CARMEL IN
46032-8724
US

IV. Provider business mailing address

PO BOX 34518
INDIANAPOLIS IN
46234-0518
US

V. Phone/Fax

Practice location:
  • Phone: 317-581-0001
  • Fax: 317-581-0002
Mailing address:
  • Phone: 317-581-0001
  • Fax: 317-581-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH R GRASEE
Title or Position: OWNER
Credential: MD
Phone: 317-581-0001