Healthcare Provider Details

I. General information

NPI: 1386480382
Provider Name (Legal Business Name): INDIGO MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 09/02/2025
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10224 DURANT RD STE 209
RALEIGH NC
27614-6468
US

IV. Provider business mailing address

10224 DURANT RD STE 209
RALEIGH NC
27614-6468
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-8255
  • Fax: 919-646-9674
Mailing address:
  • Phone: 919-322-8255
  • Fax: 919-646-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORI PEELE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 919-824-9818