Healthcare Provider Details

I. General information

NPI: 1063852135
Provider Name (Legal Business Name): KENT B REMLEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12289 HANCOCK ST SUITE 34
CARMEL IN
46032-5801
US

IV. Provider business mailing address

12289 HANCOCK ST SUITE 34
CARMEL IN
46032-5801
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-8950
  • Fax: 317-815-8951
Mailing address:
  • Phone: 317-815-8950
  • Fax: 317-815-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENT B REMLEY
Title or Position: OWNER
Credential: MD
Phone: 317-441-8687