Basic Information
| Provider Information | |||||||||
| NPI: | 1528635125 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHADELAND ANESTHESIA & PAIN ASSOCIATES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11595 N MERIDIAN ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460324544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179911664 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3738 LANDMARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479056655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7658072780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | KOWLOWITZ | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3177067246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.