MEDICARE: NEAL EDWARD IPEMA M.D.

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	207V00000X	Obstetrics & Gynecology Physician	036.123815	IL
2	207V00000X	Obstetrics & Gynecology Physician	01071411A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	400280	OTHER	IL	GROUP MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000775099	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659693679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL EDWARD IPEMA M.D.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 TOWN CENTER RD S
Second Line	:	SUITEB
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2321
Country	:	US
Telephone Number	:	317-497-2300
Fax Number	:	317-497-2502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	11/27/2023

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Directions to “ NEAL EDWARD IPEMA M.D.” Practice Location

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