Healthcare Provider Details

I. General information

NPI: 1649201005
Provider Name (Legal Business Name): FRANK DUGGER BLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W WASHINGTON ST MAJOR HOSPITAL
SHELBYVILLE IN
46176
US

IV. Provider business mailing address

5366 LAVA LANE
INDIANAPOLIS IN
46237-3042
US

V. Phone/Fax

Practice location:
  • Phone: 317-398-5275
  • Fax:
Mailing address:
  • Phone: 317-782-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number22678
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: