MEDICARE: INDIANA HEART SURGEONS, PC

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1386690246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA HEART SURGEONS, PC

Provider Business Mailing Address
First Line	:	PO BOX 2191
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-2191
Country	:	US
Telephone Number	:	317-621-1234
Fax Number	:	317-355-3128

Provider Business Practice Location Address
First Line	:	5445 E 16TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4869
Country	:	US
Telephone Number	:	317-621-1234
Fax Number	:	317-355-3128

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT E SHOEMAKER
Credential	:	MD
Telephone Number	:	317-621-1234

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/22/2020

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