# CARDIOTHORACIC SURGEONS PEDIATRICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154537850
- **Authorized official:** TERESA KRUSE (BUSINESS LINE ADMINISTRATOR)
- **Authorized official phone:** (317) 948-0944

## Contact information

- **Practice address:** 545 BARNHILL DR \# EH215, INDIANAPOLIS, IN 46202-5112
- **Practice address phone:** (317) 948-0944
- **Mailing address:** PO BOX 636762, CINCINNATI, OH 45263-0001
- **Mailing address phone:** (317) 948-7048
- **Mailing address fax:** (317) 274-2940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204F00000X | Transplant Surgery Physician | — | NULL | — |
| 204F00000X | Transplant Surgery Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | NULL | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | — | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 05/16/2007
- **Last updated:** 12/06/2018