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General NPI Number Information
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NPI Number | 1841507605
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Entity Type | Individual
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Provider Name | JOHN EDWARD HUMISTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 12265 HANCOCK ST STE 42
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City | CARMEL
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State | IN
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Zip | 46032-5892
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Country | US
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Telephone | 317-606-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 12265 HANCOCK ST STE 42
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City | CARMEL
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State | IN
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Zip | 46032-5892
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Country | US
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Telephone | 317-606-8778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A83402
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 01081516A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | A83402
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01081516A
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License Number State | IN
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