Healthcare Provider Details

I. General information

NPI: 1760422778
Provider Name (Legal Business Name): JOHN CHAMPLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 E 146TH ST STE 300
NOBLESVILLE IN
46060-5006
US

IV. Provider business mailing address

8101 CLEARVISTA PKWY STE 185
INDIANAPOLIS IN
46256-4696
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-9000
  • Fax:
Mailing address:
  • Phone: 317-621-9000
  • Fax: 317-621-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01051071A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01051071A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: