Healthcare Provider Details

I. General information

NPI: 1265690085
Provider Name (Legal Business Name): INDIANA UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BARNHILL DR EH 202
INDIANAPOLIS IN
46202-5112
US

IV. Provider business mailing address

400 E 7TH ST
BLOOMINGTON IN
47405-3001
US

V. Phone/Fax

Practice location:
  • Phone: 317-273-4966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number11013860A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11013860A
License Number StateIN

VIII. Authorized Official

Name: DR. RAY KRIS CHIHARA
Title or Position: RESIDENT
Credential: MD
Phone: 317-289-0411