LARISSA M DIMITROV (NPI# 1386827053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386827053 |
| Entity Type | Individual |
| Full Name | LARISSA M DIMITROV |
| Credential | MD |
| Practice Address |
2001 W 86th St Indianapolis IN 46260 |
| Mailing Address |
250 N Shadeland Ave Ste 200 Indianapolis IN 46219-4959 |
| Practice Telephone | 3173382345 |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2020-11-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01062576A | IN | Allopathic & Osteopathic Physicians |
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
01062576A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | LICENSE | 01062576A | 01 |
| Street Address |
2001 W 86TH ST |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46260 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021829 | Bassem I Razzouk | Pediatrics | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2005-05-27 |
| 1881209294 | Jennifer L Maupin | Nurse Practitioner | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-09-11 |
| 1851904973 | Taylor Anne Vandervort | Registered Nurse | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-08-28 |
| 1437762796 | Casey Michelle O'neal | Registered Nurse | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-08-26 |
| 1396360590 | Kathleen Sue Lilegdon | Dietitian, Registered | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-06-12 |
| 1033732979 | Rachel Leigh Thelen | Physician Assistant | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-05-27 |
| 1942823976 | Shelby Nichole Preston | Dietitian, Registered | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-05-26 |
| 1396367165 | Gabrielle Ann Vickery | Registered Nurse | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-05-14 |
| 1154950798 | Kaylee Elizabeth Poole | Pharmacist | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-04-06 |
| 1326677014 | Julie Mary Bittar | Student in an Organized Health Care Education/Training Program | 2001 W 86th St, Indianapolis, IN 46260-1902 | 2020-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508478298 | Verity Smile Studio, LLC | Clinic/Center | 1619 W. 86th St Suite B, Indianapolis, IN 46260 | 2020-08-23 |
| 1225666589 | Alexander Michael Kiel | Student in an Organized Health Care Education/Training Program | Internal Medicine 3 North, 2001 W. 86th Street, Indianapolis, IN 46260 | 2020-03-31 |
| 1043793151 | Lisa R Foreman | Registered Nurse | 1389 W. 86th Street Unit # 238, Indianapolis, IN 46260 | 2018-09-13 |
| 1790268399 | Esther Muturi | Chore Provider | 1214 Racquetclub South Drive Apt C, Indianapolis, IN 46260 | 2018-09-10 |
| 1912483215 | Katherine Donnelly | Community Health Worker | 1612 Lancashire Ct, Indianapolis, IN 46260 | 2018-07-19 |
| 1326539628 | Peaceful Source Midwifery LLC | Advanced Practice Midwife | 1139 Canterbury Ct., Unit B, Indianapolis, IN 46260 | 2018-05-22 |
| 1144722695 | Mindful Services Center LLC | Clinic/Center | 9002 N Meridian St, Ste 200, Indianapolis, IN 46260 | 2018-03-01 |
| 1144731910 | Meenu Jain | Student in an Organized Health Care Education/Training Program | Internal Medicine, 8414 Naab Road, Suite 100, Indianapolis, IN 46260 | 2017-10-19 |
| 1609392422 | 1717 Senior Living, LLC | Assisted Living Facility | 1703 West 86th Street, Indianapolis, IN 46260 | 2017-08-15 |
| 1093246985 | Royalty Transports LLC | Bus | 2255 W. 67th St., Indianapolis, IN 46260 | 2017-03-23 |
| Find all providers in zip 46260 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073125225 | Relymd Medical Group In, LLC | Family Medicine | 9221 Crawfordsville Rd, Indianapolis, IN 46234-1521 | 2020-08-19 |
| 1134765993 | Basil Vareldzis | Family Medicine | 9125 Nautical Watch Dr, Indianapolis, IN 46236-9036 | 2019-11-26 |
| 1366084329 | Rebekah Venable | Family Medicine | 5455 W 86th St Ste 210, Indianapolis, IN 46268-1530 | 2019-10-11 |
| 1710455738 | Physicians Wellness Associates LLC | Family Medicine | 4735 Statesmen Drive, Suite C, Indianapolis, IN 46250 | 2018-11-07 |
| 1386150043 | Brengle Family Medicine | Family Medicine | 8803 N Meridian St Ste 350, Indianapolis, IN 46260-5386 | 2017-12-18 |
| 1164937249 | Amy Cheung | Family Medicine | 6484 N Chester Ave, Indianapolis, IN 46220-4422 | 2017-12-11 |
| 1578017182 | Medical Specialty LLC | Family Medicine | 2301 N Meridian St, Indianapolis, IN 46208-5729 | 2016-08-11 |
| 1245685742 | Christopher Basom | Family Medicine | 8501 E 56th St Ste 120, Indianapolis, IN 46216-2118 | 2016-05-03 |
| 1760846877 | Catherine Gambale Trigonis | Family Medicine | 404 E Washington St Ste A, Indianapolis, IN 46204 | 2016-04-06 |
| 1205204203 | Community Health Network | Family Medicine | 1643 E Hanna Ave, Ste 108, Indianapolis, IN 46227-3655 | 2015-09-08 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46260 |
Please comment or provide details below to improve the information on LARISSA M DIMITROV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.