Healthcare Provider Details

I. General information

NPI: 1245302538
Provider Name (Legal Business Name): SADOVE PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 106TH ST
INDIANAPOLIS IN
46290-1004
US

IV. Provider business mailing address

3925 RIVER CROSSING PKWY THIRD FLOOR
INDIANAPOLIS IN
46240-2279
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-0330
  • Fax: 317-846-5719
Mailing address:
  • Phone: 317-472-2220
  • Fax: 317-208-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: ALAN MICHAEL SADOVE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-575-0330