Healthcare Provider Details

I. General information

NPI: 1699946046
Provider Name (Legal Business Name): JOHN T YOUNG, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 N MERIDIAN ST SUITE 200
INDIANAPOLIS IN
46208-5848
US

IV. Provider business mailing address

3231 N MERIDIAN ST SUITE 200
INDIANAPOLIS IN
46208-5848
US

V. Phone/Fax

Practice location:
  • Phone: 317-923-2301
  • Fax: 317-923-4046
Mailing address:
  • Phone: 317-923-2301
  • Fax: 317-923-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number18679
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN T YOUNG
Title or Position: MD OWNER
Credential: M.D.
Phone: 317-923-2301