Healthcare Provider Details

I. General information

NPI: 1376044784
Provider Name (Legal Business Name): KIDS ENT OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD STE 150
INDIANAPOLIS IN
46260-1974
US

IV. Provider business mailing address

10111 DITCH RD
CARMEL IN
46032-8897
US

V. Phone/Fax

Practice location:
  • Phone: 317-903-4675
  • Fax: 317-614-7154
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN TRIGG
Title or Position: PRESIDENT
Credential: MD
Phone: 773-386-7035