Healthcare Provider Details

I. General information

NPI: 1023457967
Provider Name (Legal Business Name): SANDRA QUICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA NGO

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 16TH ST STE 4100
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-7171
  • Fax: 317-963-7346
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number01082433A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125-062954
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number11020196A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01082433A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: