Healthcare Provider Details

I. General information

NPI: 1487734018
Provider Name (Legal Business Name): UROLOGY OF INDIANA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 N POST RD STE A
INDIANAPOLIS IN
46219-4254
US

IV. Provider business mailing address

679 E COUNTY LINE RD
GREENWOOD IN
46143-1049
US

V. Phone/Fax

Practice location:
  • Phone: 317-895-6095
  • Fax: 317-895-6195
Mailing address:
  • Phone: 317-885-1250
  • Fax: 317-859-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY G. ORRIS
Title or Position: M.D. /OWNER
Credential: M.D.
Phone: 317-859-7222