Healthcare Provider Details

I. General information

NPI: 1851620801
Provider Name (Legal Business Name): INDIANAPOLIS NEUROSURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 BARNHILL DR RT, 2ND FLOOR
INDIANAPOLIS IN
46202-5116
US

IV. Provider business mailing address

8333 NAAB RD SUITE 255
INDIANAPOLIS IN
46260-5924
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8111
  • Fax: 317-278-3185
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-396-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK CANTRELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 317-396-1300