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General NPI Number Information
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NPI Number | 1821402447
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Entity Type | Organization
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Legal Business Name | UROGYN AND GYN WELLNESS
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 2060 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-1762
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Country | US
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Telephone | 317-661-1079
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Fax | 844-661-1080
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Provider Business Mailing Address
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Address Line | PO BOX 68108
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-0108
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Country | US
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Telephone | 317-661-1079
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Fax | 844-661-1080
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Authorized Official
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Title or Position | UROGYNECOLOGIST
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Name | DANITA HARRISON AKINGBA
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Credential | MD
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Telephone | 317-661-1079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10667104
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License Number State | IN
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