Healthcare Provider Details

I. General information

NPI: 1336142827
Provider Name (Legal Business Name): THOMAS C DUGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

6100 W 96TH ST SUITE 125
INDIANAPOLIS IN
46278-6005
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-5171
  • Fax: 317-865-5172
Mailing address:
  • Phone: 317-715-1800
  • Fax: 317-715-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01038350A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: