Healthcare Provider Details

I. General information

NPI: 1760313522
Provider Name (Legal Business Name): SOPRIS CLINICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13625 GOLDEN RIDGE LN
FISHERS IN
46055-9648
US

IV. Provider business mailing address

13625 GOLDEN RIDGE LN
FISHERS IN
46055-9648
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES JANSSENS
Title or Position: OWNER
Credential: DO
Phone: 317-296-4077