Healthcare Provider Details

I. General information

NPI: 1952352882
Provider Name (Legal Business Name): FRANK R KOLISEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 INNOVATION PKWY #100
GREENWOOD IN
46143-3602
US

IV. Provider business mailing address

8450 NORTHWEST BLVD.
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 317-884-5200
  • Fax: 317-884-5360
Mailing address:
  • Phone: 317-802-2000
  • Fax: 317-802-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01039720
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: