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General NPI Number Information
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NPI Number | 1396160339
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Entity Type | Organization
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Legal Business Name | CHEYENNE ENTERPRISES
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 6100 N KEYSTONE AVE SUITE 105
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-2452
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Country | US
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Telephone | 317-253-7795
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Fax | 317-253-7798
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Provider Business Mailing Address
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Address Line | 6100 N KEYSTONE AVE SUITE 105
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-2452
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Country | US
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Telephone | 317-253-7795
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Fax | 317-253-7798
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | SHEILA B THOMAS
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Credential | DO
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Telephone | 317-253-7795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02003529B
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License Number State | IN
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