Healthcare Provider Details

I. General information

NPI: 1801899778
Provider Name (Legal Business Name): HOMER F BELTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 TECHNOLOGY CENTER DR
INDIANAPOLIS IN
46278-6013
US

IV. Provider business mailing address

5901 TECHNOLOGY CENTER DR
INDIANAPOLIS IN
46278-6013
US

V. Phone/Fax

Practice location:
  • Phone: 317-328-5050
  • Fax: 317-715-9965
Mailing address:
  • Phone: 317-328-5050
  • Fax: 317-715-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01023783A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: