MEDICARE: INDIANA EMERGENCY PHYSICIANS, LLP

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1255738985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA EMERGENCY PHYSICIANS, LLP

Provider Business Mailing Address
First Line	:	75 REMIT DR # 1122
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60675-0001
Country	:	US
Telephone Number	:	800-210-7034
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W NORTHWOOD DR
Second Line	:
City	:	SULLIVAN
State	:	IN
Zip	:	47882-7515
Country	:	US
Telephone Number	:	877-311-2675
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DERIK K KING
Credential	:	MD
Telephone Number	:	866-916-5259

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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