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General NPI Number Information
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NPI Number | 1144667635
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Entity Type | Organization
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Legal Business Name | INDIANA SPINE GROUP, PC
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 1115 N. RONALD REAGAN PKWY. SUITE 148
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City | AVON
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State | IN
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Zip | 46123-6913
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Country | US
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Telephone | 317-228-7000
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Fax | 317-228-2321
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Provider Business Mailing Address
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Address Line | 13225 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46032-5480
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Country | US
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Telephone | 317-228-7000
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Fax | 317-228-2321
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Authorized Official
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Title or Position | CEO
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Name | HARDEEP SIKAND
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Credential | MBA
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Telephone | 317-228-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 50004386A
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License Number State | IN
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