Organization
CLEANSLATE MEDICAL GROUP OF INDIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW PHILIP SMOLAREK (CFO)
(412) 999-5188
Entity
Organization
Contact information
Practice address
101 N HARRISON ST, ALEXANDRIA, IN 46001-2017
(765) 233-0903
(833) 279-7074
Mailing address
8 CADILLAC DR STE 300, BRENTWOOD, TN 37027-5337
(615) 425-0220
(833) 279-7074
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
05/06/2016
Last updated
12/17/2025
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