Healthcare Provider Details

I. General information

NPI: 1033030028
Provider Name (Legal Business Name): PREP PERFECTION INDY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10207 ARAPAHOE DR
INDIANAPOLIS IN
46235-8241
US

IV. Provider business mailing address

10207 ARAPAHOE DR
INDIANAPOLIS IN
46235-8241
US

V. Phone/Fax

Practice location:
  • Phone: 317-500-3689
  • Fax:
Mailing address:
  • Phone: 317-500-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO TAYLOR
Title or Position: OWNER
Credential:
Phone: 317-500-3689