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General NPI Number Information
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NPI Number | 1588535496
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Entity Type | Organization
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Legal Business Name | COMMUNITY PHYSICIAN NETWORK SPECIALTY CARE LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 8075 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2693
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Country | US
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Telephone | 317-621-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 7330 SHADELAND STA STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3985
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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 | EXEC VP
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Name | RAMARAO YELETI
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Credential | MD
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Telephone | 317-887-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology 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 | 2086X0206X
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Taxonomy Name | Surgical Oncology 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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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