Healthcare Provider Details

I. General information

NPI: 1992065924
Provider Name (Legal Business Name): ADMIRAL MEDICAL DIABETIC EDUCATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 07/17/2024
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 E 75TH ST STE 148
INDIANAPOLIS IN
46250-2717
US

IV. Provider business mailing address

6330 E 75TH ST STE 148
INDIANAPOLIS IN
46250-2717
US

V. Phone/Fax

Practice location:
  • Phone: 317-537-9522
  • Fax: 317-219-0550
Mailing address:
  • Phone: 317-537-9522
  • Fax: 317-545-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD GRAVES
Title or Position: GEN MGR
Credential:
Phone: 317-828-7517