MEDICARE: STEPPING STONE INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01068696A	IN

General Provider Information

NPI Number	:	1225581168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPPING STONE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	5785 N DELAWARE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2527
Country	:	US
Telephone Number	:	513-377-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	5785 N DELAWARE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2527
Country	:	US
Telephone Number	:	513-377-5859
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ERIC DJENGE
Credential	:	M.D.
Telephone Number	:	513-377-5859

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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Directions to “STEPPING STONE INSTITUTE, LLC ” Practice Location

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