Healthcare Provider Details

I. General information

NPI: 1548602170
Provider Name (Legal Business Name): MR. TRAVIS MCCLOSKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 HANCOCK ST STE 27
CARMEL IN
46032-2930
US

IV. Provider business mailing address

12315 HANCOCK ST STE 27
CARMEL IN
46032-5885
US

V. Phone/Fax

Practice location:
  • Phone: 317-727-1625
  • Fax: 317-975-0650
Mailing address:
  • Phone: 317-688-1113
  • Fax: 317-975-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001402A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: