Healthcare Provider Details

I. General information

NPI: 1649672676
Provider Name (Legal Business Name): CARDINAL PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

155 E MARKET ST 425
INDIANAPOLIS IN
46204-3294
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-5121
  • Fax:
Mailing address:
  • Phone: 800-526-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE CREESE
Title or Position: PRESIDENT
Credential: MD
Phone: 800-526-6797