Healthcare Provider Details

I. General information

NPI: 1104181601
Provider Name (Legal Business Name): INDIANA UNIVERSITY SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST # M200 INDIANA UNIVERSITY DEPARTMENT OF DERMATOLOGY
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

1001 W 10TH ST # M200 INDIANA UNIVERSITY DEPARTMENT OF DERMATOLOGY
INDIANAPOLIS IN
46202-2859
US

V. Phone/Fax

Practice location:
  • Phone: 317-312-7030
  • Fax: 317-630-2667
Mailing address:
  • Phone: 317-312-7030
  • Fax: 317-630-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11016587A
License Number StateIN

VIII. Authorized Official

Name: KRISTIN CARTWRIGHT
Title or Position: ADMIN HOUSE STAFF COORDINATOR
Credential:
Phone: 317-656-4260