Healthcare Provider Details

I. General information

NPI: 1316970585
Provider Name (Legal Business Name): PROFESSIONAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3266 N MERIDIAN ST SUITE 900
INDIANAPOLIS IN
46208-5846
US

IV. Provider business mailing address

3266 N MERIDIAN ST SUITE 900
INDIANAPOLIS IN
46208-5846
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-8297
  • Fax: 317-924-8348
Mailing address:
  • Phone: 317-924-8297
  • Fax: 317-924-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA A GOLDBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 317-924-8297