Healthcare Provider Details

I. General information

NPI: 1700337920
Provider Name (Legal Business Name): KLEDZIK PSYCHIATRIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 N MERIDIAN ST 225
INDIANAPOLIS IN
46260-1836
US

IV. Provider business mailing address

9245 N MERIDIAN ST 225
INDIANAPOLIS IN
46260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-9000
  • Fax: 317-818-9009
Mailing address:
  • Phone: 317-818-9000
  • Fax: 317-818-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01065931A
License Number StateIN

VIII. Authorized Official

Name: DR. ANN KLEDZIK
Title or Position: OWNER OF LLC
Credential: M.D.
Phone: 317-818-9000