Healthcare Provider Details

I. General information

NPI: 1417934746
Provider Name (Legal Business Name): C. NORMAN HURWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 N. SHADELAND AVE. SUITE A
INDIANAPOLIS IN
46219-1706
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 317-275-8072
  • Fax: 317-275-8018
Mailing address:
  • Phone: 214-932-8029
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01056709A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: