Healthcare Provider Details

I. General information

NPI: 1679677702
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY SUITE 1600
AVON IN
46123-7085
US

IV. Provider business mailing address

6820 PARKDALE PL SUITE 200
INDIANAPOLIS IN
46254-6601
US

V. Phone/Fax

Practice location:
  • Phone: 317-329-7430
  • Fax: 317-329-7485
Mailing address:
  • Phone: 317-329-7430
  • Fax: 317-329-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN H PARK
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 317-580-6307