Organization
MIRAVISTA DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE J WHEAT M.D. (PRESIDENT AND DIRECTOR)
(317) 856-2681
Entity
Organization
Contact information
Practice address
4444 DECATUR BLVD, SUITE 300, INDIANAPOLIS, IN 46241-9537
(317) 856-2681
(317) 856-3685
Mailing address
4444 DECATUR BLVD, SUITE 300, INDIANAPOLIS, IN 46241-9537
(317) 856-2681
(317) 856-3685
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7182293
CAP (COLLEGE OF AM PATH)
—
Enumeration date
06/21/2006
Last updated
08/22/2020
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