Healthcare Provider Details

I. General information

NPI: 1164603049
Provider Name (Legal Business Name): CRISTIANE MAYUMI UENO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BARNHILL DR STE 232
INDIANAPOLIS IN
46202-5112
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-3636
  • Fax: 317-968-1371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35144055
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01070412A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: