Healthcare Provider Details

I. General information

NPI: 1588387450
Provider Name (Legal Business Name): DHP OF INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 INTELLIPLEX DR
SHELBYVILLE IN
46176-8580
US

IV. Provider business mailing address

1643 NW 136TH AVE. BLDG. H, SUITE 100
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 317-392-3211
  • Fax:
Mailing address:
  • Phone: 954-377-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ADA ARAGONESES
Title or Position: PROVIDER ENROLLMENT DIRECTOR
Credential:
Phone: 954-377-2909