Healthcare Provider Details

I. General information

NPI: 1225309073
Provider Name (Legal Business Name): INDIANA PHYSICIAN MANAGEMENT-MERCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 S A ST
ELWOOD IN
46036-1942
US

IV. Provider business mailing address

7197 SOLUTION CTR
CHICAGO IL
60677-7001
US

V. Phone/Fax

Practice location:
  • Phone: 765-552-4000
  • Fax:
Mailing address:
  • Phone: 317-870-0480
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEWART BICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-844-7440