Healthcare Provider Details

I. General information

NPI: 1205416948
Provider Name (Legal Business Name): CORY OWENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 WISHARD BLVD FL RG6
INDIANAPOLIS IN
46202-2872
US

IV. Provider business mailing address

355 W 16TH ST
INDIANAPOLIS IN
46202-2207
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-5450
  • Fax:
Mailing address:
  • Phone: 859-218-5038
  • Fax: 317-963-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberTP348
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01097067A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: