Healthcare Provider Details

I. General information

NPI: 1902161706
Provider Name (Legal Business Name): JOSE ALEXANDRE PEREIRA PEDROSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2012
Last Update Date: 07/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

7108 WESTHAVEN CIR APT 106
ZIONSVILLE IN
46077-7742
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-5000
  • Fax:
Mailing address:
  • Phone: 317-709-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11016469A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: