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General NPI Number Information
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NPI Number | 1134412075
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Entity Type | Organization
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Legal Business Name | OBJECTIVE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 8330 NAAB ROAD SUITE 140
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City | INDIANAPOLIS
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State | IN
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Zip | 46260
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Country | US
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Telephone | 800-639-5191
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Fax | 855-809-9989
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Provider Business Mailing Address
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Address Line | 8330 NAAB RD SUITE 140
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5925
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Country | US
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Telephone | 800-639-5191
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Fax | 855-809-9989
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT C. GREGORI
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Credential | M.D.
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Telephone | 800-639-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology 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 | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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