Healthcare Provider Details

I. General information

NPI: 1619473360
Provider Name (Legal Business Name): OURHEALTH PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12734 PARKSIDE DR
FISHERS IN
46038-4270
US

IV. Provider business mailing address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-3255
  • Fax: 844-675-6719
Mailing address:
  • Phone: 866-434-3255
  • Fax: 866-422-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID KENNEDY
Title or Position: IMPLEMENTATION MANAGER
Credential:
Phone: 317-559-0970