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NPI Code Detail

MEDICARE: CROWN RADIOLOGY ASSOCIATES

MEDICARE: CROWN RADIOLOGY ASSOCIATES
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1417479247
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROWN RADIOLOGY ASSOCIATES
Provider Business Mailing Address
First Line : 602 N HIGH SCHOOL RD STE A2
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3694
Country : US
Telephone Number : 317-731-6929
Fax Number :
Provider Business Practice Location Address
First Line : 602 N HIGH SCHOOL RD STE A2
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3694
Country : US
Telephone Number : 317-731-6929
Fax Number :
Authorized Official
Title or Position : CEO
Name : EMMANUEL AIYEVBEKPEN OSAGIEDE
Credential : MD
Telephone Number : 219-756-4600
Provider Enumeration Date : 07/13/2017
Last Update Date : 07/20/2021

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Directions to “CROWN RADIOLOGY ASSOCIATES ” Practice Location

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