Healthcare Provider Details

I. General information

NPI: 1538435524
Provider Name (Legal Business Name): IU MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2012
Last Update Date: 03/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WISHARD BLVD 4TH FLOOR
INDIANAPOLIS IN
46202-2872
US

IV. Provider business mailing address

8910 PURDUE RD STE 500
INDIANAPOLIS IN
46268-3161
US

V. Phone/Fax

Practice location:
  • Phone: 317-692-2323
  • Fax:
Mailing address:
  • Phone: 317-692-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CELIA SURFACE-BRUDER
Title or Position: COO
Credential:
Phone: 317-871-8812