Healthcare Provider Details

I. General information

NPI: 1760459713
Provider Name (Legal Business Name): SUSAN K KINDIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 PURDUE RD STE 7
INDIANAPOLIS IN
46268-6129
US

IV. Provider business mailing address

8780 PURDUE RD STE 7
INDIANAPOLIS IN
46268-6129
US

V. Phone/Fax

Practice location:
  • Phone: 317-471-8701
  • Fax: 317-471-8702
Mailing address:
  • Phone: 317-471-8701
  • Fax: 317-471-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01043649A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01043649A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: