Provider Demographics
NPI:1891825147
Name:SADEK, NATALIE M (PA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:SADEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:M
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10122 E 10TH STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2664
Mailing Address - Country:US
Mailing Address - Phone:317-869-2320
Mailing Address - Fax:317-869-2330
Practice Address - Street 1:10122 E 10TH STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2664
Practice Address - Country:US
Practice Address - Phone:317-869-2320
Practice Address - Fax:317-869-2330
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000918A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400027047Medicare PIN
IN115450WWMedicare PIN