Healthcare Provider Details

I. General information

NPI: 1578792271
Provider Name (Legal Business Name): INDIANA CLINIC-NEUROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BARNHILL DR EH 125
INDIANAPOLIS IN
46202-5112
US

IV. Provider business mailing address

545 BARNHILL DR EH 125
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 Number
License Number State

VIII. Authorized Official

Name: PAT HURLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-274-8800