Individual
SUSAN I IVANCEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7340 SHADELAND STA, SUITE 200, INDIANAPOLIS, IN 46256-3979
(317) 806-8260
(317) 806-8296
Mailing address
7340 SHADELAND STA, SUITE 200, INDIANAPOLIS, IN 46256-3979
(317) 806-8260
(317) 806-8296
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01043743A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000208329
ANTHEM
IN
05
—
200047420
—
IN
Enumeration date
06/14/2006
Last updated
11/14/2014
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