Healthcare Provider Details

I. General information

NPI: 1699732297
Provider Name (Legal Business Name): STEPHEN M DOWNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-808-0573
  • Fax:
Mailing address:
  • Phone: 317-963-7917
  • Fax: 317-962-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01055195A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: