Healthcare Provider Details

I. General information

NPI: 1174518864
Provider Name (Legal Business Name): CHARLES H TRIPPLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 SUITE 1100
AVON IN
46123-9575
US

IV. Provider business mailing address

8244 E US HIGHWAY 36 SUITE 1100
AVON IN
46123-9575
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-7500
  • Fax: 317-272-7515
Mailing address:
  • Phone: 317-272-7500
  • Fax: 317-272-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01034946A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: