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General NPI Number Information
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NPI Number | 1912252594
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Entity Type | Organization
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Legal Business Name | INDIANA UNIVERSITY
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1001 W 10TH ST # M200
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2859
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Country | US
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Telephone | 317-365-4260
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 W 10TH ST # M200
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2859
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Country | US
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Telephone | 317-365-4260
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Fax |
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Authorized Official
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Title or Position | PROFESSOR OF MEDICINE
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Name | DR. MITCHELL GOLDMAN
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Credential | M.D
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Telephone | 317-630-6857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11016515A
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License Number State | IN
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