Healthcare Provider Details

I. General information

NPI: 1588080725
Provider Name (Legal Business Name): JOSHI PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 LAFAYETTE RD SUITE 200
CRAWFORDSVILLE IN
47933-1098
US

IV. Provider business mailing address

1901 LAFAYETTE RD SUITE 200
CRAWFORDSVILLE IN
47933-1098
US

V. Phone/Fax

Practice location:
  • Phone: 765-366-5230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01049312
License Number StateIN

VIII. Authorized Official

Name: ANITA JOSHI
Title or Position: OWNER
Credential: MD
Phone: 765-366-5230