Healthcare Provider Details

I. General information

NPI: 1265945810
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 OAKLANDON RD STE 130
INDIANAPOLIS IN
46236-9554
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1111
  • Fax: 317-621-1110
Mailing address:
  • Phone: 317-621-9366
  • Fax: 317-957-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY L JAVORKA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 317-621-1591