MEDICARE: JOSEPHSON-WALLACK-MUNSHOWER NEUROLOGY PC

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	2084N0400X	Neurology Physician		IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ9849	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396832556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPHSON-WALLACK-MUNSHOWER NEUROLOGY PC

Provider Business Mailing Address
First Line	:	6983 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2054
Country	:	US
Telephone Number	:	317-308-2800
Fax Number	:	317-576-6311

Provider Business Practice Location Address
First Line	:	2330 S DIXON RD STE 325
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-6430
Country	:	US
Telephone Number	:	317-308-2800
Fax Number	:	765-865-3935

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	NIKKI SWINEY
Credential	:
Telephone Number	:	317-308-2800

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	05/28/2026

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