Healthcare Provider Details

I. General information

NPI: 1942353362
Provider Name (Legal Business Name): AESTHETIC PLASTIC SURGERY OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188A N MERIDIAN ST SUITE 115
CARMEL IN
46032-4578
US

IV. Provider business mailing address

12188A N MERIDIAN ST SUITE 115
CARMEL IN
46032-4578
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-5400
  • Fax: 317-848-9314
Mailing address:
  • Phone: 317-848-5400
  • Fax: 317-848-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01024839A
License Number StateIN

VIII. Authorized Official

Name: RICHARD B LINDERMAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 317-848-5400