Healthcare Provider Details

I. General information

NPI: 1518306885
Provider Name (Legal Business Name): INDRA BOLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 UNIVERSITY BLVD
DUBLIN OH
43016-3508
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-7677
  • Fax: 614-293-1456
Mailing address:
  • Phone: 614-293-7677
  • Fax: 614-293-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.143026
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number35.143026
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036152122
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: