Healthcare Provider Details

I. General information

NPI: 1154872810
Provider Name (Legal Business Name): U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 W RAYMOND ST SUITE A-D
INDIANAPOLIS IN
46241-4364
US

IV. Provider business mailing address

25124 SPRINGFIELD CT SUITE 200
VALENCIA CA
91355-1085
US

V. Phone/Fax

Practice location:
  • Phone: 317-241-8266
  • Fax: 317-247-4978
Mailing address:
  • Phone: 661-678-2600
  • Fax: 661-678-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH T MALLAS
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 661-678-2600