Healthcare Provider Details

I. General information

NPI: 1093011793
Provider Name (Legal Business Name): MCGOL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W 86TH ST
INDIANAPOLIS IN
46260-1907
US

IV. Provider business mailing address

7100 HULL RD # 101
ZIONSVILLE IN
46077-8379
US

V. Phone/Fax

Practice location:
  • Phone: 317-697-9470
  • Fax:
Mailing address:
  • Phone: 317-697-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01065617A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. MAHESH GOEL
Title or Position: PARTNER
Credential:
Phone: 317-697-9470