Healthcare Provider Details

I. General information

NPI: 1174199590
Provider Name (Legal Business Name): SERGIO NICOLAS PAEZ-CALDERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD RM 641
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

550 UNIVERSITY BLVD RM 641
INDIANAPOLIS IN
46202-5149
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0010
  • Fax:
Mailing address:
  • Phone: 317-274-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11024798A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number289621
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: