Healthcare Provider Details

I. General information

NPI: 1285019851
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 S DIXON ROAD SUITE 200
KOKOMO IN
46902-6423
US

IV. Provider business mailing address

2312 S DIXON ROAD SUITE 200
KOKOMO IN
46902-6423
US

V. Phone/Fax

Practice location:
  • Phone: 765-865-6633
  • Fax: 765-865-6634
Mailing address:
  • Phone: 765-865-6633
  • Fax: 765-865-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY JAVORKA
Title or Position: COO
Credential:
Phone: 317-621-1591