MEDICARE: OPTIMUM HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1205798626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	7964 CARDINAL CV E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4651
Country	:	US
Telephone Number	:	317-608-7454
Fax Number	:	317-934-7855

Provider Business Practice Location Address
First Line	:	7964 CARDINAL CV E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4651
Country	:	US
Telephone Number	:	317-608-7454
Fax Number	:	317-934-7855

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	KANDACE L DESADIER
Credential	:	NP
Telephone Number	:	317-608-7454

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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