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General NPI Number Information
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NPI Number | 1275760498
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Entity Type | Individual
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Provider Name | GEOFFREY DANIEL LIVELY MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 10580 N MERIDIAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1028
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Country | US
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Telephone | 317-583-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 N MERIDIAN ST # 300
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 0101250395
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 01075071A
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License Number State | IN
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