Healthcare Provider Details

I. General information

NPI: 1265520837
Provider Name (Legal Business Name): LAN SHU CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/21/2011
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: 317-274-2384
Mailing address:
  • Phone: 317-274-8800
  • Fax: 317-274-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA45777
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number01062646A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: