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Contact Information

INDIANA ENDOVASCULAR SPECIALISTS LLC
3743 LANDMARK DR STE 300
LAFAYETTE, IN47905-6656
 Phone: 317-656-9089
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
 

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for INDIANA ENDOVASCULAR SPECIALISTS LLC

NPI Number 1417616525
LBN Legal business name INDIANA ENDOVASCULAR SPECIALISTS LLC
Authorized official BRANDON MARTINEZ - (OWNER AND MEDICAL DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/16/2021
Last updated 02/22/2022 - About 4 years ago
Identifiers
IN Medicaid 201022130
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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