Healthcare Provider Details

I. General information

NPI: 1003840208
Provider Name (Legal Business Name): IVANA RADOVANOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S EAST ST STE C
INDIANAPOLIS IN
46227-1991
US

IV. Provider business mailing address

11 TRAFALGAR SQ
TRAFALGAR IN
46181-9515
US

V. Phone/Fax

Practice location:
  • Phone: 317-534-4660
  • Fax: 317-782-4301
Mailing address:
  • Phone: 317-680-9103
  • Fax: 317-878-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD20050640
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: