Healthcare Provider Details

I. General information

NPI: 1790743367
Provider Name (Legal Business Name): PERKINS VAN NATTA PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 106TH ST
CARMEL IN
46290-1004
US

IV. Provider business mailing address

170 W 106TH ST
CARMEL IN
46290-1004
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-0330
  • Fax: 317-846-5719
Mailing address:
  • Phone: 317-575-0330
  • Fax: 317-846-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JENNY MEHLING
Title or Position: PATIENT ACCOUNT REPRESENTATIVE
Credential:
Phone: 317-663-7247