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General NPI Number Information
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NPI Number | 1801573381
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Entity Type | Organization
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Legal Business Name | INDY ADHD LLC
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 38 W MAIN ST
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City | CARMEL
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State | IN
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Zip | 46032-1764
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Country | US
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Telephone | 317-939-3681
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Fax |
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Provider Business Mailing Address
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Address Line | 20078 CHATHAM GREEN DR
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City | WESTFIELD
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State | IN
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Zip | 46074-4370
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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 | PSYCHIATRIST
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Name | DR. JEREMIAH ELLINGSWORTH
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Credential | DO
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Telephone | 812-240-6368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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