Healthcare Provider Details

I. General information

NPI: 1982819017
Provider Name (Legal Business Name): INDIANAPOLIS INSTITUTE FOR PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 450
INDIANAPOLIS IN
46237-8600
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 450
INDIANAPOLIS IN
46237-8600
US

V. Phone/Fax

Practice location:
  • Phone: 317-859-3259
  • Fax: 317-859-3265
Mailing address:
  • Phone: 317-859-3259
  • Fax: 317-859-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01026775
License Number StateIN

VIII. Authorized Official

Name: DR. CHARLES E HUGHES
Title or Position: OWNER
Credential: MD
Phone: 317-859-3259