Healthcare Provider Details

I. General information

NPI: 1295713576
Provider Name (Legal Business Name): AARON SCOTT CARLISLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 E 116TH ST SUITE 300
FISHERS IN
46038-2820
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1500
  • Fax: 317-621-1509
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057378A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: