Healthcare Provider Details

I. General information

NPI: 1063879823
Provider Name (Legal Business Name): AUSTIN DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5144 E STOP 11 RD STE 24
INDIANAPOLIS IN
46237-8606
US

IV. Provider business mailing address

5144 E STOP 11 RD STE 24
INDIANAPOLIS IN
46237-8606
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-3853
  • Fax:
Mailing address:
  • Phone: 317-497-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001331A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: