Individual
NICHOLAS STEPHEN IANNAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-5820
(317) 962-3916
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02005669A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
02005669A
IN
207RP1001X
Pulmonary Disease Physician
Primary
02005669A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11018796A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
267030314
MEDICARE PTAN
IN
05
—
300026216
—
IN
Enumeration date
06/06/2016
Last updated
03/13/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us