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General NPI Number Information
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NPI Number | 1881143907
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Entity Type | Organization
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Legal Business Name | U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 7301 GEORGETOWN RD SUITE 109 - 111
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-5124
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Country | US
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Telephone | 317-875-9584
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Fax | 317-872-2850
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Provider Business Mailing Address
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Address Line | 25124 SPRINGFIELD CT SUITE 200
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City | VALENCIA
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State | CA
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Zip | 91355-1085
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Country | US
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Telephone | 661-678-2600
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Fax | 661-678-2700
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MR. JOSEPH T MALLAS
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Credential |
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Telephone | 661-678-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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