Healthcare Provider Details

I. General information

NPI: 1942303151
Provider Name (Legal Business Name): THOMAS J EADS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SOUTH PARK BLVD
GREENWOOD IN
46143
US

IV. Provider business mailing address

53 SOUTH PARK BLVD
GREENWOOD IN
46143
US

V. Phone/Fax

Practice location:
  • Phone: 317-889-7546
  • Fax: 317-889-2482
Mailing address:
  • Phone: 317-889-7546
  • Fax: 317-889-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01047160
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: