Healthcare Provider Details

I. General information

NPI: 1588697759
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: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 N MERIDIAN ST SUITE 100
INDIANAPOLIS IN
46260-5300
US

IV. Provider business mailing address

8803 N MERIDIAN ST SUITE 100
INDIANAPOLIS IN
46260-5300
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-4070
  • Fax: 317-848-9452
Mailing address:
  • Phone: 317-848-4070
  • Fax: 317-848-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateIN

VIII. Authorized Official

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