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General NPI Number Information
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NPI Number | 1942483318
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Entity Type | Organization
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Legal Business Name | ADVANCED MIGRAINE CARE, P.C.
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Dates
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Enumeration Date | 12/08/2007
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Last Update Date | 12/08/2007
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Provider Practice Location Address
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Address Line | 13430 N MERIDIAN ST SUITE 165
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City | CARMEL
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State | IN
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Zip | 46032-1405
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Country | US
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Telephone | 317-582-8270
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Fax | 317-582-8271
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Provider Business Mailing Address
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Address Line | 13430 N MERIDIAN ST SUITE 165
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City | CARMEL
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State | IN
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Zip | 46032-1405
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Country | US
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Telephone | 317-582-8270
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Fax | 317-582-8271
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD DAVID ZDOBYLAK
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Credential | MD
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Telephone | 317-582-8270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01051068A
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License Number State | IN
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