Healthcare Provider Details

I. General information

NPI: 1073568390
Provider Name (Legal Business Name): VIVIAN SANFORD HOWARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

8777 WINTERGREEN WAY
INDIANAPOLIS IN
46256-4309
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-0181
  • Fax: 317-554-0105
Mailing address:
  • Phone: 317-841-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01034717A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: