Healthcare Provider Details

I. General information

NPI: 1861445918
Provider Name (Legal Business Name): HEARTLAND NEUROLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 W CARMEL DR STE D-3
CARMEL IN
46032-8708
US

IV. Provider business mailing address

1185 W CARMEL DR STE D-3
CARMEL IN
46032-8708
US

V. Phone/Fax

Practice location:
  • Phone: 317-249-0990
  • Fax: 317-249-0999
Mailing address:
  • Phone: 317-249-0990
  • Fax: 317-249-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE A NUKES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-249-0990