Healthcare Provider Details

I. General information

NPI: 1285812818
Provider Name (Legal Business Name): INDIANA PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 DONALD S POWERS DRIVE SUITE 201A
MUNSTER IN
46321-4057
US

IV. Provider business mailing address

10110 DONALD S POWERS DRIVE SUITE 201A
MUNSTER IN
46321-4057
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A ROBINSON
Title or Position: PRESIDENT
Credential: MD
Phone: 219-513-2100