Healthcare Provider Details

I. General information

NPI: 1114764123
Provider Name (Legal Business Name): CAMERON HARMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W 10TH ST
INDIANAPOLIS IN
46202-3082
US

IV. Provider business mailing address

340 W 10TH ST
INDIANAPOLIS IN
46202-3082
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8157
  • Fax:
Mailing address:
  • Phone: 317-274-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11024894A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: