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General NPI Number Information
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NPI Number | 1376044784
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Entity Type | Organization
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Legal Business Name | KIDS ENT OF INDIANA LLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 8240 NAAB RD STE 150
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1974
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Country | US
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Telephone | 317-903-4675
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Fax | 317-614-7154
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Provider Business Mailing Address
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Address Line | 10111 DITCH RD
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City | CARMEL
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State | IN
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Zip | 46032-8897
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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 | PRESIDENT
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Name | DR. DEAN TRIGG
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Credential | MD
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Telephone | 773-386-7035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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