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General NPI Number Information
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NPI Number | 1679677702
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Entity Type | Organization
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Legal Business Name | AMERICAN HEALTH NETWORK OF INDIANA, LLC
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 1111 RONALD REAGAN PKWY SUITE 1600
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City | AVON
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State | IN
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Zip | 46123-7085
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Country | US
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Telephone | 317-329-7430
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Fax | 317-329-7485
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Provider Business Mailing Address
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Address Line | 6820 PARKDALE PL SUITE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-6601
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Country | US
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Telephone | 317-329-7430
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Fax | 317-329-7485
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | BEN H PARK
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Credential | MD
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Telephone | 317-580-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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