Healthcare Provider Details

I. General information

NPI: 1306884234
Provider Name (Legal Business Name): INFECTIOUS DISEASE OF INDIANA, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 NORTH MERIDIAN STREET SUITE 200
CARMEL IN
46032-1680
US

IV. Provider business mailing address

11455 NORTH MERIDIAN STREET SUITE 200
CARMEL IN
46032-1680
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8180
  • Fax: 317-582-8185
Mailing address:
  • Phone: 317-582-8180
  • Fax: 317-582-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER BELCHER
Title or Position: PRESIDENT
Credential: MD
Phone: 317-582-8180