MEDICARE: KEELY ANNE RADOSEVIC

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	363L00000X	Nurse Practitioner	28198674A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1487680518	OTHER	IN	GROUP NPI
2	677730	OTHER	IN	GROUP PTAN

General Provider Information

NPI Number	:	1851828636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEELY ANNE RADOSEVIC

Provider Business Mailing Address
First Line	:	679 E COUNTY LINE RD
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1049
Country	:	US
Telephone Number	:	317-807-1262
Fax Number	:	317-859-4269

Provider Business Practice Location Address
First Line	:	1270 N POST RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4254
Country	:	US
Telephone Number	:	317-895-6095
Fax Number	:	317-895-6195

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	01/19/2024

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Directions to “ KEELY ANNE RADOSEVIC ” Practice Location

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