MEDICARE: INDIANA GENERAL SURGERY, P.C.

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1609889526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA GENERAL SURGERY, P.C.

Provider Business Mailing Address
First Line	:	3520 GUION RD
Second Line	:	SUITE 301
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1692
Country	:	US
Telephone Number	:	317-924-4009
Fax Number	:	317-926-8410

Provider Business Practice Location Address
First Line	:	3520 GUION RD
Second Line	:	SUITE 301
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1692
Country	:	US
Telephone Number	:	317-924-4009
Fax Number	:	317-926-8410

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. WENDY L BUCKLER
Credential	:	CMM
Telephone Number	:	317-924-4009

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/11/2007

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