Healthcare Provider Details

I. General information

NPI: 1437066834
Provider Name (Legal Business Name): LUM NORTH INDY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11876 OLIO RD
FISHERS IN
46037-9765
US

IV. Provider business mailing address

11876 OLIO RD
FISHERS IN
46037-9765
US

V. Phone/Fax

Practice location:
  • Phone: 574-968-5166
  • Fax:
Mailing address:
  • Phone: 574-968-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DANILE G KLAUER
Title or Position: OWNER
Credential: DDS
Phone: 574-968-5166