Basic Information
Provider Information
NPI: 1003018250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALCATERRA
FirstName: DOMENICO
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 250 N SHADELAND AVE
Address2: STE 130 PROVIDER ENROLLMENT
City: INDIANAPOLIS
State: IN
PostalCode: 462194959
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1801 N SENATE BLVD
Address2: STE 3300
City: INDIANAPOLIS
State: IN
PostalCode: 462021228
CountryCode: US
TelephoneNumber: 3179231787
FaxNumber: 3179626259
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 09/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X01071025AINY Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 
208G00000XME97069FLN Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 
208G00000X38062IAN Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

ID Information
IDTypeStateIssuerDescription
20108018005IN MEDICAID


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