Healthcare Provider Details

I. General information

NPI: 1275747313
Provider Name (Legal Business Name): AVON PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 BUSINESS CENTER DR SUITE A
AVON IN
46123-8662
US

IV. Provider business mailing address

7376 BUSINESS CENTER DR SUITE A
AVON IN
46123-8662
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-7887
  • Fax: 317-272-7888
Mailing address:
  • Phone: 317-272-7887
  • Fax: 317-272-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01044494
License Number StateIN

VIII. Authorized Official

Name: KERRY L HENSLEY
Title or Position: OWNER
Credential: M.D.
Phone: 317-272-7887