Healthcare Provider Details

I. General information

NPI: 1437154028
Provider Name (Legal Business Name): ANDREW J DENARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13345 ILLINOIS ST
CARMEL IN
46032-3318
US

IV. Provider business mailing address

13345 ILLINOIS ST
CARMEL IN
46032-3318
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-352-3417
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-352-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM-17162
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101046026
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01042295A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: