Individual
MRS. SUSAN MARIE HOLEC-IWASKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11100 USA PKWY STE A100, FISHERS, IN 46037-9255
(317) 678-3850
(317) 968-1142
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0200
IN
207Q00000X
Family Medicine Physician
Primary
02001359A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000173793
ANTHEM PIN
IN
05
—
100218910
—
IN
01
—
264430H57
MEDICARE PTAN
IN
01
—
4299039
AETNA PIN
IN
Enumeration date
01/31/2007
Last updated
10/03/2023
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