Healthcare Provider Details

I. General information

NPI: 1215705926
Provider Name (Legal Business Name): MONARCH RESTORATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 EXECUTIVE DR SUITE A & B
CARMEL IN
46032
US

IV. Provider business mailing address

90 EXECUTIVE DR SUITE A & B
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 317-804-4203
  • Fax: 317-564-0627
Mailing address:
  • Phone: 317-804-4203
  • Fax: 317-564-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA CLAY
Title or Position: OWNER
Credential: MD
Phone: 309-265-6864