Healthcare Provider Details

I. General information

NPI: 1386757672
Provider Name (Legal Business Name): INDY ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 86TH AVE SUITE P
MERRILLVILLE IN
46410-6173
US

IV. Provider business mailing address

521 E 86TH AVE SUITE P
MERRILLVILLE IN
46410-6173
US

V. Phone/Fax

Practice location:
  • Phone: 219-755-4550
  • Fax: 219-755-4652
Mailing address:
  • Phone: 219-755-4550
  • Fax: 219-755-4652

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: HARRY MOFFITT
Title or Position: PRESIDENT
Credential: DO
Phone: 219-755-4550