Individual
DMITRIY SERGEEVICK TCKACHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 577-4200
(317) 577-9503
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01089003A
IN
207L00000X
Anesthesiology Physician
35378
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117490
—
AZ
01
—
1285645531
ANTHEM PTAN
IN
05
—
300071919
—
IN
01
—
P00353901
MEDICARE RAILROAD
—
Enumeration date
08/11/2006
Last updated
11/19/2025
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