Healthcare Provider Details

I. General information

NPI: 1831633502
Provider Name (Legal Business Name): JAMES LEGRAND MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 S EMERSON AVE SUITE H
INDIANAPOLIS IN
46237-8668
US

IV. Provider business mailing address

7855 S EMERSON AVE SUITE H
INDIANAPOLIS IN
46237-8668
US

V. Phone/Fax

Practice location:
  • Phone: 317-300-0370
  • Fax: 317-300-0422
Mailing address:
  • Phone: 317-300-0370
  • Fax: 317-300-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01041511A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01041511A
License Number StateIN

VIII. Authorized Official

Name: JAMES E LEGRAND
Title or Position: PROPRIETER
Credential: MD
Phone: 317-300-0370