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General NPI Number Information
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NPI Number | 1376957753
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Entity Type | Organization
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Legal Business Name | ERTEL AND COMPANY
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 9795 CROSSPOINT BLVD SUITE 170
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3354
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Country | US
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Telephone | 317-577-2777
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Fax | 317-577-2954
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Provider Business Mailing Address
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Address Line | 9795 CROSSPOINT BLVD SUITE 170
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3354
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Country | US
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Telephone | 317-577-2777
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Fax | 317-577-2954
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AMY KILEY ERTEL
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Credential | M.D.
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Telephone | 317-577-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01049468A
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License Number State | IN
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