Healthcare Provider Details

I. General information

NPI: 1558314922
Provider Name (Legal Business Name): INDIANA HEART ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W JEFFERSON ST SUITE A
FRANKLIN IN
46131-2147
US

IV. Provider business mailing address

920 N SHADELAND AVE SUITE G1
INDIANAPOLIS IN
46219-4898
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-7651
  • Fax: 317-736-7337
Mailing address:
  • Phone: 317-355-9783
  • Fax: 317-355-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number50003647A
License Number StateIN

VIII. Authorized Official

Name: DR. RAMARAO YELETI
Title or Position: PRESIDENT
Credential: MD
Phone: 317-621-8666