Healthcare Provider Details

I. General information

NPI: 1235871724
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11787 LANTERN RD STE 200
FISHERS IN
46038-2801
US

IV. Provider business mailing address

11787 LANTERN RD STE 200
FISHERS IN
46038-2801
US

V. Phone/Fax

Practice location:
  • Phone: 317-957-9140
  • Fax: 317-957-9141
Mailing address:
  • Phone: 317-957-9140
  • Fax: 317-957-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY KIRKHAM
Title or Position: CFO
Credential:
Phone: 317-497-6169