MEDICARE: DR. RICHARD DEAN KIOVSKY 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	207Q00000X	Family Medicine Physician	01027093A	IN

General Provider Information

NPI Number	:	1780640664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD DEAN KIOVSKY M.D.

Provider Business Mailing Address
First Line	:	DEPARTMENT OF FAMILY MEDICINE, LO 260
Second Line	:	1110 W. MICHIGAN STREET
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5102
Country	:	US
Telephone Number	:	317-278-0310
Fax Number	:	317-274-4444

Provider Business Practice Location Address
First Line	:	1 AMERICAN SQ STE 185
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46282-0003
Country	:	US
Telephone Number	:	317-278-6161
Fax Number	:	317-638-0678

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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