MEDICARE: NEUROSURGICAL ASSOCIATES OF INDIANA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	01032585	IN

General Provider Information

NPI Number	:	1043213648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSURGICAL ASSOCIATES OF INDIANA, PC

Provider Business Mailing Address
First Line	:	7369 SHADELAND STATION WAY
Second Line	:	STE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3958
Country	:	US
Telephone Number	:	317-577-3900
Fax Number	:	317-579-7459

Provider Business Practice Location Address
First Line	:	7369 SHADELAND STATION WAY
Second Line	:	STE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3958
Country	:	US
Telephone Number	:	317-577-3900
Fax Number	:	317-579-7459

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. JEREMY P GILBERT
Credential	:
Telephone Number	:	317-577-3900

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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