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General NPI Number Information
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NPI Number | 1518179167
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Entity Type | Organization
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Legal Business Name | MEDICAL EVALUATION SERVICES
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 3833 N MERIDIAN ST SUITE 10
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4039
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Country | US
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Telephone | 317-283-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 3833 N MERIDIAN ST SUITE 10
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4039
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Country | US
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Telephone | 317-283-8113
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR ADMINISTRATOR
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Name | MR. DOUGLAS WREGE
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Credential |
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Telephone | 317-283-8113
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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 | 01056999A
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License Number State | IN
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