Healthcare Provider Details

I. General information

NPI: 1245269778
Provider Name (Legal Business Name): JOSHUA J UNDERHILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 WITTENBRAKER AVE
NEW CASTLE IN
47362-5000
US

IV. Provider business mailing address

PO BOX 485
NEW CASTLE IN
47362-0485
US

V. Phone/Fax

Practice location:
  • Phone: 765-599-3100
  • Fax: 765-518-5365
Mailing address:
  • Phone: 765-521-1516
  • Fax: 765-599-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01069630A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-099663
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301076217
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: