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General NPI Number Information
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NPI Number | 1477889285
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Entity Type | Organization
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Legal Business Name | PERSONALIZED HEALTHCARE OF CARMEL, LLC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 11900 N PENNSYLVANIA ST SUITE 200
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City | CARMEL
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State | IN
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Zip | 46032-4693
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Country | US
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Telephone | 317-663-7123
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Fax | 317-663-7123
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Provider Business Mailing Address
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Address Line | 11900 N PENNSYLVANIA ST SUITE 200
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City | CARMEL
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State | IN
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Zip | 46032-4693
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Country | US
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Telephone | 317-663-7123
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Fax | 317-663-7123
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLIFFORD W FETTERS
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Credential | MD
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Telephone | 317-663-7128
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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 | 01034557A
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License Number State | IN
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