MEDICARE: ALLERGY ASSOCIATES OF CENTRAL IN

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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1356374516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY ASSOCIATES OF CENTRAL IN

Provider Business Mailing Address
First Line	:	3850 SHORE DR
Second Line	:	SUITE 105
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5621
Country	:	US
Telephone Number	:	317-290-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 SHORE DR
Second Line	:	SUITE 105
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5621
Country	:	US
Telephone Number	:	317-290-0940
Fax Number	:

Authorized Official
Title or Position	:	ASSIST. EXECUTIVE DIRE
Name	:	MRS. KATHY BARNETT
Credential	:
Telephone Number	:	317-924-8208

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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