| Jeffrey L Loughead, MD | |
|
2001 W 86th St, Indianapolis, IN 46260-1902 | |
| (317) 415-7921 | |
| (317) 415-7922 |
| Full Name | Jeffrey L Loughead |
|---|---|
| Gender | Male |
| Speciality | Pediatrics - Neonatal-perinatal Medicine |
| Location | 2001 W 86th 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 |
|---|---|---|---|
| 1548254394 | NPI | - | NPPES |
| 036097718 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2080N0001X | Pediatrics - Neonatal-perinatal Medicine | 01091889A (Indiana) | Secondary |
| 2080N0001X | Pediatrics - Neonatal-perinatal Medicine | 036-097718 (Illinois) | Primary |
| Entity Name | Lurie Children's Medical Group Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1518064716 PECOS PAC ID: 4789597279 Enrollment ID: O20031111000157 |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey L Loughead, MD 225 E Chicago Ave # 152, Chicago, IL 60611-2991 Ph: (630) 933-6602 | Jeffrey L Loughead, MD 2001 W 86th St, Indianapolis, IN 46260-1902 Ph: (317) 415-7921 |
Mohannad Moallem, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 705 Riley Hospital Dr, Indianapolis, IN 46202 Phone: 317-274-4779 Fax: 317-948-9806 | |
Tracey Wilkinson, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 705 Riley Hospital Dr Ste 1300, Indianapolis, IN 46202 Phone: 317-962-8067 | |
Joshua Wayne Gollub, Pediatrics Medicare: Medicare Enrolled Practice Location: 705 Riley Hospital Dr, Indianapolis, IN 46202 Phone: 317-274-4779 Fax: 317-948-9806 | |
Katherine Carlsen Anderson, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1701 N Senate Blvd # Ag012, Indianapolis, IN 46202 Phone: 317-962-3525 | |
Ivana Radovanovic, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 5550 S East St Ste C, Indianapolis, IN 46227 Phone: 317-534-4660 Fax: 317-782-4301 | |
Samuel J Flanders, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 250 N Shadeland Ave, Ste 200, Indianapolis, IN 46219 Phone: 317-962-4836 Fax: 317-962-8646 | |
Mark H Hoyer, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 705 Riley Hospital Dr, Rr 127, Indianapolis, IN 46202 Phone: 317-274-8906 Fax: 317-274-4022 |