Healthcare Provider Details

I. General information

NPI: 1780640664
Provider Name (Legal Business Name): RICHARD DEAN KIOVSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMERICAN SQ STE 185
INDIANAPOLIS IN
46282-0003
US

IV. Provider business mailing address

DEPARTMENT OF FAMILY MEDICINE, LO 260 1110 W. MICHIGAN STREET
INDIANAPOLIS IN
46202-5102
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-6161
  • Fax: 317-638-0678
Mailing address:
  • Phone: 317-278-0310
  • Fax: 317-274-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01027093A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: