Healthcare Provider Details

I. General information

NPI: 1467459206
Provider Name (Legal Business Name): DON ARMENOFF P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 STE 1100
AVON IN
46123-9627
US

IV. Provider business mailing address

8019 FISHBACK RD
INDIANAPOLIS IN
46278-1027
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000330A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: