Healthcare Provider Details

I. General information

NPI: 1821218363
Provider Name (Legal Business Name): AGEWELL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9292 N MERIDIAN ST SUITE 107
INDIANAPOLIS IN
46260-1857
US

IV. Provider business mailing address

9292 N MERIDIAN ST SUITE 107
INDIANAPOLIS IN
46260-1857
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-9792
  • Fax:
Mailing address:
  • Phone: 317-846-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50003950A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number50003950A
License Number StateIN

VIII. Authorized Official

Name: DR. STEPHEN ALAN RAPPAPORT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-846-9792