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NPI 1538346689

NPI 1538346689 : INDIANA SPINE GROUP, PC : INDIANAPOLIS, IN

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General NPI Number Information
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    NPI Number           |    1538346689
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    Entity Type          |    Organization 
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    Legal Business Name  |    INDIANA SPINE GROUP, PC 
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Dates
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    Enumeration Date     |    01/30/2008
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    Last Update Date     |    05/27/2016
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Provider Practice Location Address
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    Address Line         |    8040 CLEARVISTA PKWY SUITE 450
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    City                 |    INDIANAPOLIS
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    State                |    IN
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    Zip                  |    46256-5630
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    Country              |    US
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    Telephone            |    317-228-7000
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    Fax                  |    317-577-0619
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Provider Business Mailing Address
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    Address Line         |    13225 N MERIDIAN ST 
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    City                 |    CARMEL
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    State                |    IN
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    Zip                  |    46032-5480
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    Country              |    US
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    Telephone            |    317-228-7000
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    Fax                  |    317-228-2321
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Authorized Official
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    Title or Position    |    CHIEF EXECUTIVE OFFICER
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    Name                 |     HARDEEP  SIKAND 
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    Credential           |    
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    Telephone            |    317-228-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    208VP0000X
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    Taxonomy Name        |    Pain Medicine Physician
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    License Number       |    
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    332B00000X
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    Taxonomy Name        |    Durable Medical Equipment & Medical Supplies
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    License Number       |    
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    License Number State |    
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Taxonomy #3
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    Taxonomy Code        |    207XS0117X
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    Taxonomy Name        |    Orthopaedic Surgery of the Spine Physician
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    License Number       |    
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    License Number State |    
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