Individual
GEORGE E REVTYAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N SENATE BLVD, SUITE 310, INDIANAPOLIS, IN 46202-1228
(317) 962-2500
(317) 962-2515
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01028670A
IN
207RC0000X
Cardiovascular Disease Physician
23373
NE
207RI0011X
Interventional Cardiology Physician
Primary
01028670A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100324050
—
IN
01
—
1257717
IA MEDICAID
IA
05
—
47076868513
—
NE
Enumeration date
03/28/2006
Last updated
03/16/2021
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