Provider Demographics
NPI:1699321307
Name:MEDICAL CONSULTANTS OF CENTRAL INDIANA LLC
Entity type:Organization
Organization Name:MEDICAL CONSULTANTS OF CENTRAL INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTOVAO
Authorized Official - Middle Name:F
Authorized Official - Last Name:VIEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-680-3250
Mailing Address - Street 1:5252 E 82ND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5704
Mailing Address - Country:US
Mailing Address - Phone:317-680-3250
Mailing Address - Fax:317-588-2647
Practice Address - Street 1:5252 E 82ND ST STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5704
Practice Address - Country:US
Practice Address - Phone:317-680-3250
Practice Address - Fax:317-588-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200992290Medicaid