Healthcare Provider Details

I. General information

NPI: 1457583064
Provider Name (Legal Business Name): INDIANA UNIVERSITY SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3031 SKYLAR LN
INDIANAPOLIS IN
46208-5078
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-4260
  • Fax:
Mailing address:
  • Phone: 859-699-1322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11014918A
License Number StateIN

VIII. Authorized Official

Name: PETER NALIN
Title or Position: ASSOC. DEAN FOR GRAD MEDICAL EDUCAT
Credential: M.D.
Phone: 317-274-8282