Healthcare Provider Details

I. General information

NPI: 1346264892
Provider Name (Legal Business Name): JOHN C KINCAID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

545 BARNHILL DR EH125
INDIANAPOLIS IN
46202-5112
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8800
  • Fax:
Mailing address:
  • Phone: 317-274-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01026276A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: