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General NPI Number Information
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NPI Number | 1912060153
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE FAMILY PHYSICIANS, INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 8523 MADISON AVE SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-6115
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Country | US
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Telephone | 317-888-2811
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Fax | 317-888-2822
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Provider Business Mailing Address
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Address Line | 8523 MADISON AVE SUITE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-6115
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Country | US
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Telephone | 317-888-2811
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Fax | 317-888-2822
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ROBIN ANN MALUCK
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Credential |
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Telephone | 317-888-2811
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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 |
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License Number State |
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