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General NPI Number Information
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NPI Number | 1508334814
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Entity Type | Organization
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Legal Business Name | EMERALD NEURO-RECOVER
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 12265 HANCOCK ST STE 42
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City | CARMEL
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State | IN
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Zip | 46032-5801
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Country | US
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Telephone | 317-606-8778
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Fax | 317-740-0534
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Provider Business Mailing Address
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Address Line | 12265 HANCOCK ST STE 42
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City | CARMEL
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State | IN
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Zip | 46032-5801
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Country | US
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Telephone | 317-606-8778
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Fax | 317-740-0534
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Authorized Official
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Title or Position | BILLING AGENT
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Name | MARGARET G DUNTEMAN
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Credential | CREDENTIALING DEPT.
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Telephone | 630-770-3800
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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 |
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License Number State |
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