Healthcare Provider Details

I. General information

NPI: 1063450542
Provider Name (Legal Business Name): PROSCAN IMAGING OF INDIANAPOLIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 W CARMEL DR SUITE D-1
CARMEL IN
46032-8706
US

IV. Provider business mailing address

1185 W CARMEL DR SUITE D-1
CARMEL IN
46032-8706
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-1700
  • Fax: 317-706-1705
Mailing address:
  • Phone: 317-706-1700
  • Fax: 317-706-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D. O'BRIEN
Title or Position: COO
Credential:
Phone: 513-281-3400