Healthcare Provider Details

I. General information

NPI: 1306935556
Provider Name (Legal Business Name): MIDWEST EAR INSTITUTE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 N SHADELAND AVE STE 150
INDIANAPOLIS IN
46250-2095
US

IV. Provider business mailing address

7440 N SHADELAND AVE STE 150
INDIANAPOLIS IN
46250-2095
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-4901
  • Fax: 317-842-4393
Mailing address:
  • Phone: 317-842-4901
  • Fax: 317-842-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberN/A
License Number StateIN

VIII. Authorized Official

Name: JAN D BABCOCK
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 317-570-7353