Healthcare Provider Details

I. General information

NPI: 1053335794
Provider Name (Legal Business Name): JAMES W HARDACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13431 OLD MERIDIAN ST STE 200
CARMEL IN
46032-1498
US

IV. Provider business mailing address

13431 OLD MERIDIAN ST STE 200
CARMEL IN
46032-1498
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-7733
  • Fax: 317-573-7739
Mailing address:
  • Phone: 317-573-7733
  • Fax: 317-573-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberIN01041884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: