Healthcare Provider Details

I. General information

NPI: 1346467628
Provider Name (Legal Business Name): HOOSIER INFECTIOUS DISEASE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W JEFFERSON ST STE S
FRANKLIN IN
46131-2728
US

IV. Provider business mailing address

704 S STATE ROAD 135 STE D293
GREENWOOD IN
46143-6561
US

V. Phone/Fax

Practice location:
  • Phone: 317-346-3892
  • Fax: 317-745-3303
Mailing address:
  • Phone: 317-690-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01043261A
License Number StateIN

VIII. Authorized Official

Name: DR. MARY E BIRCH
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 317-690-1733