Provider Demographics
NPI:1871295485
Name:YEDLICKA, GRACE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:YEDLICKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 UNIVERSITY BLVD RM 641
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-948-2444
Mailing Address - Fax:317-944-1848
Practice Address - Street 1:550 UNIVERSITY BLVD RM 641
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-2444
Practice Address - Fax:317-944-1848
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program