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General NPI Number Information
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NPI Number | 1801399100
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Entity Type | Organization
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Legal Business Name | EXTENDED CARE MEDICAL DOCTORS
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 10475 CROSSPOINT BLVD STE 250
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3387
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Country | US
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Telephone | 317-813-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 10475 CROSSPOINT BLVD STE 250
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3387
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | M M NOOR US SHAMS
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Credential |
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Telephone | 346-208-2408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal 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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IN
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