Healthcare Provider Details

I. General information

NPI: 1194380519
Provider Name (Legal Business Name): OLGA LIZ VERA COLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ESKENAZI AVE # F2-600
INDIANAPOLIS IN
46202-5173
US

IV. Provider business mailing address

640 ESKENAZI AVE # F2-600
INDIANAPOLIS IN
46202-5173
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-5570
  • Fax:
Mailing address:
  • Phone: 317-278-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01099849A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: