Provider Demographics
NPI:1730137563
Name:SLOAN, LEEANDREA (MD)
Entity type:Individual
Prefix:
First Name:LEEANDREA
Middle Name:
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 - PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2625 E 62ND ST
Practice Address - Street 2:SUITE 2010
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3189
Practice Address - Country:US
Practice Address - Phone:317-251-6121
Practice Address - Fax:317-257-0390
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048962A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200300160Medicaid
IN715530J5Medicare PIN
IN200300160Medicaid
ING94693Medicare UPIN
INP01132985Medicare PIN