Healthcare Provider Details

I. General information

NPI: 1164735270
Provider Name (Legal Business Name): INDIANA UNIVERITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2010
Last Update Date: 07/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST # M200
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

742 BLAKE ST APT C
INDIANAPOLIS IN
46202-2972
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-4260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11015397A
License Number StateIN

VIII. Authorized Official

Name: AHMAD ALHADER
Title or Position: INTERNAL MEDICINE RESIDENT
Credential:
Phone: 317-529-6264