Basic Information
| Provider Information | |||||||||
| NPI: | 1356572473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIMBIL | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | LY-BALEILYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7411 HEATHROW WAY STE A | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462419527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178523505 | ||||||||
| FaxNumber: | 3178933053 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 E COUNTY LINE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178852860 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125057224 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01072665A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 01072665A | IN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 201179900 | 05 | IN | MEDICAID |