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General NPI Number Information
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NPI Number | 1700337920
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Entity Type | Organization
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Legal Business Name | KLEDZIK PSYCHIATRIC LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 9245 N MERIDIAN ST 225
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1836
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Country | US
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Telephone | 317-818-9000
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Fax | 317-818-9009
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Provider Business Mailing Address
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Address Line | 9245 N MERIDIAN ST 225
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1836
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Country | US
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Telephone | 317-818-9000
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Fax | 317-818-9009
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Authorized Official
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Title or Position | OWNER OF LLC
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Name | DR. ANN KLEDZIK
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Credential | M.D.
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Telephone | 317-818-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 01065931A
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License Number State | IN
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