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General NPI Number Information
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NPI Number | 1942510623
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Entity Type | Organization
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Legal Business Name | MY MD HOUSECALLS, LLC
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 9002 N MERIDIAN ST SUITE 209
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5381
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Country | US
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Telephone | 317-848-4460
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Fax | 317-848-4493
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Provider Business Mailing Address
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Address Line | 801 W ANN ARBOR TRL SUITE 200
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City | PLYMOUTH
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State | MI
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Zip | 48170-1694
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Country | US
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Telephone | 734-414-9990
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Fax | 775-258-1535
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Authorized Official
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Title or Position | MEMBER
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Name | KEVIN R RUARK
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Credential |
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Telephone | 734-414-9990
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | IN
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Taxonomy #5
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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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