Healthcare Provider Details

I. General information

NPI: 1366436461
Provider Name (Legal Business Name): DAVID M CAMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

9526 MAZE RD
INDIANAPOLIS IN
46259-9652
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-5000
  • Fax:
Mailing address:
  • Phone: 317-752-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01060052
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: