Healthcare Provider Details

I. General information

NPI: 1528070224
Provider Name (Legal Business Name): MIDWEST COLON & RECTAL SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 OLD MERIDIAN ST SUITE 210
CARMEL IN
46032-1427
US

IV. Provider business mailing address

13421 OLD MERIDIAN ST SUITE 210
CARMEL IN
46032-1427
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-5273
  • Fax: 317-844-5709
Mailing address:
  • Phone: 317-844-5273
  • Fax: 317-844-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. JANEAN YOUNG
Title or Position: OFFICE MANAGER
Credential:
Phone: 317-844-5273