Healthcare Provider Details

I. General information

NPI: 1558879544
Provider Name (Legal Business Name): ALICIA N. SANDERS, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9460 E 146TH ST
NOBLESVILLE IN
46060-4966
US

IV. Provider business mailing address

6605 ROTHCHILD BLVD
INDIANAPOLIS IN
46278-1769
US

V. Phone/Fax

Practice location:
  • Phone: 317-703-1999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA SANDERS
Title or Position: COO
Credential: MD
Phone: 317-460-2673