Healthcare Provider Details

I. General information

NPI: 1144305400
Provider Name (Legal Business Name): INDIANA NEUROSCIENCE ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 CASTLEPLACE DR # 130
INDIANAPOLIS IN
46250-1902
US

IV. Provider business mailing address

6330 CASTLEPLACE DR # 130
INDIANAPOLIS IN
46250-1902
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number50001071A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number50001071A
License Number StateIN

VIII. Authorized Official

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