Healthcare Provider Details

I. General information

NPI: 1194066811
Provider Name (Legal Business Name): INDIANA NEUROSCIENCE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E COUNTY LINE RD STE E
INDIANAPOLIS IN
46227-0873
US

IV. Provider business mailing address

6330 CASTLEPLACE DR STE 130
INDIANAPOLIS IN
46250-1902
US

V. Phone/Fax

Practice location:
  • Phone: 317-570-7900
  • Fax: 317-570-2288
Mailing address:
  • Phone: 317-570-7900
  • Fax: 317-570-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL H LEVINE
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 317-570-7900