Organization
CARDIOTHORACIC SURGEONS PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA KRUSE (BUSINESS LINE ADMINISTRATOR)
(317) 948-0944
Entity
Organization
Contact information
Practice address
545 BARNHILL DR # EH215, INDIANAPOLIS, IN 46202-5112
(317) 948-0944
Mailing address
PO BOX 636762, CINCINNATI, OH 45263-0001
(317) 948-7048
(317) 274-2940
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
—
—
208600000X
Surgery Physician
—
—
2086S0120X
Pediatric Surgery Physician
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Enumeration date
05/16/2007
Last updated
12/06/2018
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