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General NPI Number Information
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NPI Number | 1073940664
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Entity Type | Organization
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Legal Business Name | UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 06/11/2016
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Provider Practice Location Address
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Address Line | 430 INDIANA AVE APT 138
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3275
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Country | US
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Telephone | 791-920-0750
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Fax |
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Provider Business Mailing Address
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Address Line | 430 INDIANA AVENUE APT 138
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City | INDIANA
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State | IN
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Zip | 46202-3275
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PGY6
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Name | DR. SHIVI S SIVA
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Credential | MD
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Telephone | 317-671-3034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 11017474A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 11017474A
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License Number State | IN
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