Provider Demographics
NPI:1730406042
Name:CALILI, LAURA B (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:CALILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:LASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
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 1:8820 S MERIDIAN STREET
Practice Address - Street 2:SUITE 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6060
Practice Address - Country:US
Practice Address - Phone:317-865-6600
Practice Address - Fax:317-865-6616
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069638A208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000719450OtherANTHEM PIN
IN201021890Medicaid
INM400048680Medicare PIN
IN068010032Medicare PIN