Healthcare Provider Details

I. General information

NPI: 1932289568
Provider Name (Legal Business Name): UROLOGY OF INDIANA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/06/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 E 138TH
FISHERS IN
46037-0050
US

IV. Provider business mailing address

679 E COUNTY LINE RD
GREENWOOD IN
46143-1049
US

V. Phone/Fax

Practice location:
  • Phone: 317-813-1660
  • Fax: 317-813-1667
Mailing address:
  • Phone: 317-885-1250
  • Fax: 317-859-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD S SUH
Title or Position: M.D.
Credential:
Phone: 317-890-2000