Healthcare Provider Details

I. General information

NPI: 1134129885
Provider Name (Legal Business Name): CARDIOTHORACIC ANESTHESIA OF INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

PO BOX 6069 DEPT 18
INDIANAPOLIS IN
46206-6069
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-6290
  • Fax: 317-870-0499
Mailing address:
  • Phone: 317-802-6290
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number50003431
License Number StateIN

VIII. Authorized Official

Name: DR. DONALD STOGSDILL
Title or Position: PRESIDENT
Credential: MD
Phone: 317-802-6290