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General NPI Number Information
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NPI Number | 1164692968
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Entity Type | Organization
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Legal Business Name | WILSHIRE MEDICAL P.C.
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 6820 PARKDALE PL STE 212
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-6601
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Country | US
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Telephone | 317-329-7022
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Fax | 317-329-7031
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Provider Business Mailing Address
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Address Line | 6820 PARKDALE PL STE 212
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-6601
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Country | US
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Telephone | 317-329-7022
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Fax | 317-329-7031
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY SOPER
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Credential | MD
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Telephone | 317-329-7022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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