| Michael L Iczkovitz, DDS | |
|
1121 W Michigan St, Indianapolis, IN 46202-5211 | |
| (317) 274-7433 | |
| (317) 274-2603 |
| Full Name | Michael L Iczkovitz |
|---|---|
| Gender | Male |
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1121 W Michigan St, Indianapolis, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235159930 | NPI | - | NPPES |
| 100079980 | Medicaid | IN | |
| 000000086698 | Other | IN | BCBS/ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2901011066 (Michigan) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12008664 (Indiana) | Primary |
| Entity Name | Indiana University |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689790552 PECOS PAC ID: 6002806957 Enrollment ID: O20040602001625 |
| Mailing Address | Practice Location Address |
|---|---|
| Michael L Iczkovitz, DDS 700 Lane 440 Lake James, Angola, IN 46703-9090 Ph: (260) 348-4316 | Michael L Iczkovitz, DDS 1121 W Michigan St, Indianapolis, IN 46202-5211 Ph: (317) 274-7433 |
Dr. Jeong Hwa Hong, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 1121 W Michigan St, Indianapolis, IN 46202 Phone: 317-274-7957 |
Charles G Abraham, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 550 University Blvd # Uh3195, Indianapolis, IN 46202 Phone: 317-274-8300 Fax: 317-274-8300 |
Noah Menaker, DDS Dentist Medicare: Medicare Enrolled Practice Location: 705 Riley Hospital Dr, Indianapolis, IN 46202 Phone: 317-944-3865 |
Alexandra Bojrab, DDS, MSD Dentist Medicare: Not Enrolled in Medicare Practice Location: 7007 Us 31, Indianapolis, IN 46227 Phone: 317-676-3065 |
Manpreet Kaur Dhanjal, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 10110 E Washington St Ste E, Indianapolis, IN 46229 Phone: 317-897-0200 |
Ryan Campbell Jay, D.D.S. Dentist Medicare: Medicare Enrolled Practice Location: 12110 Pendleton Pike, Indianapolis, IN 46236 Phone: 317-826-1050 Fax: 317-826-1065 |
Dr. Iris Corina Mcnicholl, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 1481 West 10th Street, Indianapolis, IN 46202 Phone: 317-988-2733 Fax: 317-988-5377 |