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General NPI Number Information
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NPI Number | 1023035482
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Entity Type | Organization
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Legal Business Name | INDIANAPOLIS NEUROSURGICAL GROUP PC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 1051 S GREENWOOD SPRINGS BLVD SUITE 210
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City | GREENWOOD
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State | IN
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Zip | 46143-6479
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Country | US
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Telephone | 317-396-1300
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Fax | 317-396-1346
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Provider Business Mailing Address
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Address Line | 1051 S GREENWOOD SPRINGS BLVD SUITE 201
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City | GREENWOOD
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State | IN
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Zip | 46143-6479
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Country | US
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Telephone | 317-396-1300
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Fax | 317-396-1346
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Authorized Official
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Title or Position | CFO
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Name | DEREK CANTRELL
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Credential |
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Telephone | 317-396-1386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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