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General NPI Number Information
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NPI Number | 1053802736
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Entity Type | Organization
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Legal Business Name | BIO-RESTORE FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 10967 ALLISONVILLE RD STE 220
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City | FISHERS
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State | IN
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Zip | 46038-2634
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Country | US
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Telephone | 317-578-1220
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Fax | 833-228-1102
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Provider Business Mailing Address
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Address Line | 914 RANCH RD
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City | CONNERSVILLE
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State | IN
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Zip | 47331-1238
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Country | US
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Telephone | 317-578-1220
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Fax | 833-228-1102
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT G MARSTELLER
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Credential | M.D.
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Telephone | 317-578-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01068656A
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License Number State | IN
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