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General NPI Number Information
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NPI Number | 1720539075
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Entity Type | Organization
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Legal Business Name | INDIANAPOLIS PERIOPERATIVE MEDICINE
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 13000 E 136TH ST STE. 1100
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City | FISHERS
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State | IN
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Zip | 46037-9478
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Country | US
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Telephone | 317-513-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 E 136TH ST STE. 1100
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City | FISHERS
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State | IN
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Zip | 46037-9478
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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 | INTERNAL MEDICINE PHYSICIAN
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Name | DR. PETER CACCAVALLO
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Credential | M.D.
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Telephone | 317-513-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10002130A
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License Number State | IN
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