Provider Demographics
NPI:1700337920
Name:KLEDZIK PSYCHIATRIC LLC
Entity type:Organization
Organization Name:KLEDZIK PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-818-9000
Mailing Address - Street 1:9245 N MERIDIAN ST
Mailing Address - Street 2:225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1836
Mailing Address - Country:US
Mailing Address - Phone:317-818-9000
Mailing Address - Fax:317-818-9009
Practice Address - Street 1:9245 N MERIDIAN ST
Practice Address - Street 2:225
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1836
Practice Address - Country:US
Practice Address - Phone:317-818-9000
Practice Address - Fax:317-818-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065931A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty