Healthcare Provider Details

I. General information

NPI: 1134412075
Provider Name (Legal Business Name): OBJECTIVE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 NAAB ROAD SUITE 140
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

8330 NAAB RD SUITE 140
INDIANAPOLIS IN
46260-5925
US

V. Phone/Fax

Practice location:
  • Phone: 800-639-5191
  • Fax: 855-809-9989
Mailing address:
  • Phone: 800-639-5191
  • Fax: 855-809-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C. GREGORI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-639-5191