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General NPI Number Information
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NPI Number | 1598285165
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Entity Type | Individual
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Provider Name | STEFANI STEVANIJA TICA MD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 705 RILEY HOSPITAL DR STE 4210
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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Country | US
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Telephone | 317-944-3774
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Fax | 317-968-1055
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Provider Business Mailing Address
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Address Line | 705 RILEY HOSPITAL DR STE 4200
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2020013471
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 2020013471
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 2020013471
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2020013471
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 01094083A
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License Number State | IN
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