Individual
ANDRES MARTIN ACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 W 11TH ST, INDIANAPOLIS, IN 46202-4108
(317) 491-6000
(317) 491-6534
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
273737
MA
207ZP0101X
Anatomic Pathology Physician
Primary
01088583A
IN
208D00000X
General Practice Physician
33128-1
ZZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275948127
ANTHEM PTAN
IN
05
—
300069964
—
IN
Enumeration date
06/29/2014
Last updated
05/05/2025
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