Healthcare Provider Details

I. General information

NPI: 1477589000
Provider Name (Legal Business Name): SHADELAND ANESTHESIA & PAIN ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 N MERIDIAN ST
INDIANAPOLIS IN
46260-2332
US

IV. Provider business mailing address

29943 NETWORK PL
CHICAGO IL
60673-1299
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-7246
  • Fax: 317-706-3419
Mailing address:
  • Phone: 317-706-3415
  • Fax: 317-706-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number154505
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDWARD KOWLOWITZ
Title or Position: OWNER
Credential: MD
Phone: 317-706-7246