Individual
DR. IVAN LUPOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 N SENATE BLVD, IUSOM DEPARTMENT OF EMERGENCY MEDICINE, ROOM AG012, INDIANAPOLIS, IN 46202-1239
(317) 962-5975
Mailing address
5034 N CAPITOL AVE, INDIANAPOLIS, IN 46208-3405
(812) 322-1487
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11018664A
IN
Other
Enumeration date
05/21/2016
Last updated
02/15/2019
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