Healthcare Provider Details

I. General information

NPI: 1265682413
Provider Name (Legal Business Name): REPRODUCTIVE CARE OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PENNSYLVANIA PKWY SUITE 310
INDIANAPOLIS IN
46280-2301
US

IV. Provider business mailing address

201 PENNSYLVANIA PKWY SUITE 310
INDIANAPOLIS IN
46280-2301
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1800
  • Fax: 317-817-1810
Mailing address:
  • Phone: 317-817-1800
  • Fax: 317-817-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number01039467A
License Number StateIN

VIII. Authorized Official

Name: DR. MICHAEL A HENRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-817-1800