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NPI Code Detail

MEDICARE: SHADELAND ANESTHESIA

MEDICARE: SHADELAND ANESTHESIA
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
1261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)IN

General Provider Information

NPI Number : 1780864926
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHADELAND ANESTHESIA
Provider Business Mailing Address
First Line : 8805 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2760
Country : US
Telephone Number : 317-706-3415
Fax Number : 317-706-3419
Provider Business Practice Location Address
First Line : 8805 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2760
Country : US
Telephone Number : 317-706-3415
Fax Number : 317-706-3419
Authorized Official
Title or Position : OWNER
Name : EDWARD KOWLOWITZ
Credential : MD
Telephone Number : 317-706-3415
Provider Enumeration Date : 11/05/2007
Last Update Date : 04/11/2025

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Directions to “SHADELAND ANESTHESIA ” Practice Location

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