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General NPI Number Information
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NPI Number | 1578017182
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Entity Type | Organization
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Legal Business Name | MEDICAL SPECIALTY LLC
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 2301 N MERIDIAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-5729
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Country | US
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Telephone | 317-602-5610
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Fax | 317-602-5730
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Provider Business Mailing Address
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Address Line | 7320 E 82ND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-1458
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Country | US
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Telephone | 317-842-5771
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Fax | 317-576-1394
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Authorized Official
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Title or Position | CEO
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Name | HAMID ABBASPOUR
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Credential |
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Telephone | 317-842-5771
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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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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 01034573A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 01034573A
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License Number State | IN
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