Healthcare Provider Details

I. General information

NPI: 1073546248
Provider Name (Legal Business Name): ALLERGY ASSOCIATES OF CENTRAL IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 CLEARVISTA PKWY 4A
INDIANAPOLIS IN
46256-1400
US

IV. Provider business mailing address

8202 CLEARVISTA PKWY 4A
INDIANAPOLIS IN
46256-1400
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-5460
  • Fax: 317-621-5468
Mailing address:
  • Phone: 317-621-5460
  • Fax: 317-621-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY BARNETT
Title or Position: ASSIST EXECUTIVE DIRECTOR
Credential:
Phone: 317-621-5460