Healthcare Provider Details

I. General information

NPI: 1740937523
Provider Name (Legal Business Name): CONNOR JAMES FOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

5845 IRON OAKS CT
INDIANAPOLIS IN
46237-9209
US

V. Phone/Fax

Practice location:
  • Phone: 131-798-8177
  • Fax:
Mailing address:
  • Phone: 217-979-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: