Organization
UNIVERSITY PEDIATRIC ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA S HANELINE MD (SECRETARY - TREASURER)
(317) 777-6435
Entity
Organization
Contact information
Practice address
705 RILEY HOSPITAL DR, RR 127, INDIANAPOLIS, IN 46202-5109
(317) 777-6435
(317) 777-6644
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097150200
—
FL
05
—
100382090
—
IN
05
—
1011388
—
VT
05
—
144666
—
AL
05
—
1510084
—
TN
05
—
200026880
—
IN
05
—
200026890
—
IN
05
—
3810016815
—
WV
Enumeration date
06/20/2006
Last updated
10/03/2024
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