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General NPI Number Information
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NPI Number | 1154537850
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Entity Type | Organization
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Legal Business Name | CARDIOTHORACIC SURGEONS PEDIATRICS LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 545 BARNHILL DR # EH215
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5112
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Country | US
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Telephone | 317-948-0944
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 636762
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City | CINCINNATI
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State | OH
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Zip | 45263-0001
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Country | US
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Telephone | 317-948-7048
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Fax | 317-274-2940
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Authorized Official
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Title or Position | BUSINESS LINE ADMINISTRATOR
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Name | TERESA KRUSE
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Credential |
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Telephone | 317-948-0944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number |
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License Number State |
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