Healthcare Provider Details

I. General information

NPI: 1134613649
Provider Name (Legal Business Name): ANDREW HILLS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 09/07/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N DAN JONES RD STE 120
PLAINFIELD IN
46168-2817
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-2612
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-7328
  • Fax: 317-837-4640
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number02007340A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number02007340A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02007340A
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: