Provider Demographics
NPI:1124078050
Name:INDIANA HEART ASSOCIATES PC
Entity type:Organization
Organization Name:INDIANA HEART ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:YELETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-621-8666
Mailing Address - Street 1:PO BOX 633711
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3711
Mailing Address - Country:US
Mailing Address - Phone:317-621-8666
Mailing Address - Fax:317-621-8604
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3051
Practice Address - Country:US
Practice Address - Phone:317-355-1234
Practice Address - Fax:317-355-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003647A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200020100AMedicaid
INCA1968Medicare PIN
IN200020100AMedicaid