Provider Demographics
NPI:1447262282
Name:UNIVERSITY PLASTIC SURGERY ASSOCIATES, PC
Entity type:Organization
Organization Name:UNIVERSITY PLASTIC SURGERY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-274-3636
Mailing Address - Street 1:545 BARNHILL DR
Mailing Address - Street 2:SUITE 232
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-274-3636
Mailing Address - Fax:317-278-7159
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:SUITE 232
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-274-3636
Practice Address - Fax:317-278-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176240Medicaid
IN521770Medicare PIN