Healthcare Provider Details

I. General information

NPI: 1982781282
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/09/2008
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

PO BOX 660242
INDIANAPOLIS IN
46266-0001
US

V. Phone/Fax

Practice location:
  • Phone: 765-552-4600
  • Fax:
Mailing address:
  • Phone: 765-552-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN H PARK
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 317-580-6309