Healthcare Provider Details

I. General information

NPI: 1699296764
Provider Name (Legal Business Name): LYNN PITTMAN DO INTERNAL MEDICINE ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 N PENNSYLVANIA ST
INDIANAPOLIS IN
46205-3415
US

IV. Provider business mailing address

3140 N WINDMILL CT
TERRE HAUTE IN
47805-8627
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-4545
  • Fax:
Mailing address:
  • Phone: 812-241-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number02002857A
License Number StateIN

VIII. Authorized Official

Name: DR. LYNN PITTMAN
Title or Position: PHYSICIAN
Credential: DO
Phone: 812-241-4749