Healthcare Provider Details

I. General information

NPI: 1083806376
Provider Name (Legal Business Name): SEYMOUR GASTROENTEROLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S PINE ST STE 311
SEYMOUR IN
47274-2367
US

IV. Provider business mailing address

225 S PINE ST STE 311
SEYMOUR IN
47274-2367
US

V. Phone/Fax

Practice location:
  • Phone: 812-523-4750
  • Fax: 812-523-4751
Mailing address:
  • Phone: 812-523-4750
  • Fax: 812-523-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number01063371A
License Number StateIN

VIII. Authorized Official

Name: RAKESH K PARIKH
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 812-523-4750