Healthcare Provider Details

I. General information

NPI: 1316961956
Provider Name (Legal Business Name): STERNLATE TSHILILIWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

13281 E LETTS LN
CARMEL IN
46074-5506
US

V. Phone/Fax

Practice location:
  • Phone: 317-583-2345
  • Fax: 317-583-3099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301081193
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01063510A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01063510A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: