Healthcare Provider Details

I. General information

NPI: 1578542049
Provider Name (Legal Business Name): SAMUEL A HARMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/27/2023
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 RIVER AVE
NOBLESVILLE IN
46062-8329
US

IV. Provider business mailing address

6626 E 75TH ST STE. 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-6579
  • Fax: 317-776-4557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number01034462A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01034462A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: