Healthcare Provider Details

I. General information

NPI: 1770538340
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS OF INDIANAPOLIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/31/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

PO BOX 7112 DEPT 31
INDIANAPOLIS IN
46207-7112
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-8148
  • Fax: 317-528-8115
Mailing address:
  • Phone: 317-802-3151
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL TODD
Title or Position: PRESIDENT
Credential: MD
Phone: 317-528-8148