Healthcare Provider Details

I. General information

NPI: 1609968858
Provider Name (Legal Business Name): AMERICAN HEALTH NETWORK OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 W. LINCOLN ROAD
KOKOMO IN
46902
US

IV. Provider business mailing address

2343 W. LINCOLN ROAD
KOKOMO IN
46902
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-4090
  • Fax: 765-455-4091
Mailing address:
  • Phone: 765-455-4090
  • Fax: 765-455-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN H PARK
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 317-580-6307