Individual
OTAR DATIASHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 353-9515
(812) 353-9275
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01093706A
IN
207P00000X
Emergency Medicine Physician
273598-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03782025
—
IN
Enumeration date
06/22/2015
Last updated
03/05/2025
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