MEDICARE: INDICARE VITALS INC

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	207R00000X	Internal Medicine Physician	01038358B	IN

General Provider Information

NPI Number	:	1386950913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDICARE VITALS INC

Provider Business Mailing Address
First Line	:	1427 W 86TH ST
Second Line	:	SUITE 326
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 W 86TH ST
Second Line	:	SUITE 326
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2103
Country	:	US
Telephone Number	:	317-332-2692
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GREGORY GORDON
Credential	:
Telephone Number	:	317-332-2692

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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Directions to “INDICARE VITALS INC ” Practice Location

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