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General NPI Number Information
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NPI Number | 1437441912
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN INDIANA DERMATOLOGY LLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 955 N MICHIGAN AVE STE 81
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City | GREENSBURG
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State | IN
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Zip | 47240-1487
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Country | US
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Telephone | 812-212-8797
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Fax |
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Provider Business Mailing Address
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Address Line | 955 N MICHIGAN AVE STE 81
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City | GREENSBURG
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State | IN
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Zip | 47240-1487
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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 | OWNER
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Name | DR. ANDREW DUBOIS
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Credential | M.D.
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Telephone | 812-212-8797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 01063413A
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License Number State | IN
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