Healthcare Provider Details

I. General information

NPI: 1912030966
Provider Name (Legal Business Name): LASER AND SKIN SURGERY CENTER OF INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 N MERIDIAN ST STE 200
INDIANAPOLIS IN
46260-2385
US

IV. Provider business mailing address

8925 N MERIDIAN ST STE 200
INDIANAPOLIS IN
46260-2385
US

V. Phone/Fax

Practice location:
  • Phone: 317-660-4900
  • Fax: 317-660-7112
Mailing address:
  • Phone: 317-660-4900
  • Fax: 317-660-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number50004010A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL WILLIAM HANKE
Title or Position: OWNER
Credential: M.D.
Phone: 317-660-4900