Provider Demographics
NPI:1538270095
Name:INDIANA INSTITUTE OF CARDIOLOGY
Entity type:Organization
Organization Name:INDIANA INSTITUTE OF CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:219-874-1400
Mailing Address - Street 1:1000 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4266
Mailing Address - Country:US
Mailing Address - Phone:219-874-1400
Mailing Address - Fax:219-874-1398
Practice Address - Street 1:1000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4266
Practice Address - Country:US
Practice Address - Phone:219-874-1400
Practice Address - Fax:219-874-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000105128OtherANTHEM GROUP NUMBER
188760Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER