Healthcare Provider Details

I. General information

NPI: 1316927072
Provider Name (Legal Business Name): LARRY M GREENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E COUNTY LINE RD SUITE 101
GREENWOOD IN
46143-1070
US

IV. Provider business mailing address

701 E COUNTY LINE RD SUITE 101
GREENWOOD IN
46143-1070
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-2860
  • Fax: 317-885-2869
Mailing address:
  • Phone: 317-885-2860
  • Fax: 317-885-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01041115
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01041115
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: