Provider Demographics
NPI:1902469034
Name:COMPLETE PEDIATRICS AND SPECIALTY CARE
Entity Type:Organization
Organization Name:COMPLETE PEDIATRICS AND SPECIALTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-987-3708
Mailing Address - Street 1:1425 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4975
Mailing Address - Country:US
Mailing Address - Phone:812-945-2229
Mailing Address - Fax:812-949-2229
Practice Address - Street 1:1425 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4975
Practice Address - Country:US
Practice Address - Phone:812-945-2229
Practice Address - Fax:812-949-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty