Healthcare Provider Details

I. General information

NPI: 1790757466
Provider Name (Legal Business Name): JOSEPH EAPEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/27/2023
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 E 146TH ST STE 200
NOBLESVILLE IN
46060-5008
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6300
  • Fax: 317-621-6310
Mailing address:
  • Phone: 317-621-9312
  • Fax: 317-621-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01063289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: