Healthcare Provider Details

I. General information

NPI: 1528091782
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 E STOP 11 RD SUITE 3
INDIANAPOLIS IN
46237-8617
US

IV. Provider business mailing address

5162 E STOP 11 RD SUITE 3
INDIANAPOLIS IN
46237-8617
US

V. Phone/Fax

Practice location:
  • Phone: 317-859-9003
  • Fax:
Mailing address:
  • Phone: 317-859-9003
  • Fax:

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: MRS. KATHY BARNETT
Title or Position: ASSIST EXECUTIVE DIRECTOR
Credential:
Phone: 317-924-8208