Healthcare Provider Details

I. General information

NPI: 1588535496
Provider Name (Legal Business Name): COMMUNITY PHYSICIAN NETWORK SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 N SHADELAND AVE
INDIANAPOLIS IN
46250-2693
US

IV. Provider business mailing address

7330 SHADELAND STA STE 200
INDIANAPOLIS IN
46256-3985
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KUNZER
Title or Position: EVP
Credential: MD
Phone: 317-355-5961