Healthcare Provider Details

I. General information

NPI: 1538346689
Provider Name (Legal Business Name): INDIANA SPINE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 CLEARVISTA PKWY SUITE 450
INDIANAPOLIS IN
46256-5630
US

IV. Provider business mailing address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

V. Phone/Fax

Practice location:
  • Phone: 317-228-7000
  • Fax: 317-577-0619
Mailing address:
  • Phone: 317-228-7000
  • Fax: 317-228-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: HARDEEP SIKAND
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 317-228-7000