Healthcare Provider Details

I. General information

NPI: 1821838590
Provider Name (Legal Business Name): THE FUNCTIONAL MDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EXECUTIVE DR STE D
CARMEL IN
46032-2993
US

IV. Provider business mailing address

2837 TRAILBLAZER CT
CARMEL IN
46032-0013
US

V. Phone/Fax

Practice location:
  • Phone: 855-659-7311
  • Fax:
Mailing address:
  • Phone: 812-655-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMRANJIT SINGH
Title or Position: MEMBER
Credential: MD
Phone: 812-655-4136