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General NPI Number Information
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NPI Number | 1598070740
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Entity Type | Organization
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Legal Business Name | MD2U INDIANA LLC
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 8888 KEYSTONE XING SUITE 1300
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-4609
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Country | US
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Telephone | 502-327-9100
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Fax | 855-632-8329
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Provider Business Mailing Address
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Address Line | PO BOX 7219
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City | LOUISVILLE
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State | KY
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Zip | 40257-0219
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Country | US
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Telephone | 502-327-9100
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Fax | 855-632-8329
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | GREGORY D LATTA
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Credential |
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Telephone | 502-327-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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