Healthcare Provider Details

I. General information

NPI: 1639430101
Provider Name (Legal Business Name): JOSEPHSON WALLACK MUNSHOWER NEUROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 S A ST
ELWOOD IN
46036-1942
US

IV. Provider business mailing address

6983 HILLSDALE CT
INDIANAPOLIS IN
46250-2054
US

V. Phone/Fax

Practice location:
  • Phone: 317-308-2800
  • Fax: 765-865-3935
Mailing address:
  • Phone: 317-308-2800
  • Fax: 317-576-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN MATTOX
Title or Position: CFO/CIO
Credential:
Phone: 317-308-2800