Provider Demographics
NPI:1902975642
Name:INDIANA PEDIATRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:INDIANA PEDIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMASRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-475-0024
Mailing Address - Street 1:655 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970
Mailing Address - Country:US
Mailing Address - Phone:765-475-0024
Mailing Address - Fax:765-475-0736
Practice Address - Street 1:655 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970
Practice Address - Country:US
Practice Address - Phone:765-475-0024
Practice Address - Fax:765-475-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty