MEDICARE: ERIC CHARLES SMUCLOVISKY 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	2085R0202X	Diagnostic Radiology Physician	01085491A	IN
2	208D00000X	General Practice Physician	R0792	TX
3	2085R0204X	Vascular & Interventional Radiology Physician	01085491A	IN

General Provider Information

NPI Number	:	1700265634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHARLES SMUCLOVISKY M.D.

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 N CAPITOL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1225
Country	:	US
Telephone Number	:	317-349-7909
Fax Number	:

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	06/13/2024

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