MEDICARE: DR. DAVID J BLACK M.D.

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	207RG0100X	Gastroenterology Physician	01034170	IN
2	207RG0100X	Gastroenterology Physician	01034170A	IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841400371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J BLACK M.D.

Provider Business Mailing Address
First Line	:	8 NORTH US 31
Second Line	:	SUITE B
City	:	WHITELAND
State	:	IN
Zip	:	46184-1546
Country	:	US
Telephone Number	:	317-787-6566
Fax Number	:	317-888-6766

Provider Business Practice Location Address
First Line	:	8 NORTH US 31
Second Line	:	SUITE B
City	:	WHITELAND
State	:	IN
Zip	:	46184-1546
Country	:	US
Telephone Number	:	317-787-6566
Fax Number	:	317-888-6766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	02/25/2022

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Directions to “ DR. DAVID J BLACK M.D.” Practice Location

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