Healthcare Provider Details

I. General information

NPI: 1265675953
Provider Name (Legal Business Name): JOSHUA S NEUCKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2009
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 225
DANVILLE IN
46122-1870
US

IV. Provider business mailing address

6983 HILLSDALE CT
INDIANAPOLIS IN
46250-2054
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4730
  • Fax:
Mailing address:
  • Phone: 317-849-8350
  • Fax: 317-576-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01072080A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: