Organization
INDIANAPOLIS PERIOPERATIVE MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER CACCAVALLO M.D. (OWNER)
(317) 678-3585
Entity
Organization
Contact information
Practice address
13000 E 136TH ST, SUITE 1100, FISHERS, IN 46037-9478
(317) 678-3585
(317) 863-5084
Mailing address
13000 E 136TH ST, SUITE 1100, FISHERS, IN 46037-9478
(317) 678-3585
(317) 863-5084
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1053181A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200424870-A
—
IN
01
—
DE0272
RR MEDICARE GROUP
IN
Enumeration date
06/29/2007
Last updated
07/15/2014
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