MEDICARE: DR. NICHOLAS FRANK HRISOMALOS M.D.

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	01032013B	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IN1940	OTHER	IN	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568452340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS FRANK HRISOMALOS M.D.

Provider Business Mailing Address
First Line	:	10300 N ILLINOIS ST
Second Line	:	SUITE1070
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1167
Country	:	US
Telephone Number	:	317-817-1500
Fax Number	:	317-817-1511

Provider Business Practice Location Address
First Line	:	10300 N ILLINOIS ST
Second Line	:	SUITE1070
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1167
Country	:	US
Telephone Number	:	317-817-1500
Fax Number	:	317-817-1511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/17/2017

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Directions to “ DR. NICHOLAS FRANK HRISOMALOS M.D.” Practice Location

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