Individual
PETR SLIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1426 BROAD RIPPLE AVE STE 200, INDIANAPOLIS, IN 46220-2002
(317) 621-3680
Mailing address
6626 E 75TH ST, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01089331A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/03/2021
Last updated
07/09/2024
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