Healthcare Provider Details

I. General information

NPI: 1356537369
Provider Name (Legal Business Name): INDIANA SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 SUITE 1210
AVON IN
46123-9575
US

IV. Provider business mailing address

8244 E US HIGHWAY 36 SUITE 1210
AVON IN
46123-9575
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-8272
  • Fax: 317-272-7507
Mailing address:
  • Phone: 317-272-8272
  • Fax: 317-272-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01036203
License Number StateIN

VIII. Authorized Official

Name: BRUCE C INMAN
Title or Position: PRESIDENT/OWNER
Credential: M. D.
Phone: 317-272-8272