MEDICARE: NEUROHEALTH OF INDIANAPOLIS 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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1699886747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROHEALTH OF INDIANAPOLIS INC

Provider Business Mailing Address
First Line	:	2060 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1764
Country	:	US
Telephone Number	:	317-635-3499
Fax Number	:	317-635-0449

Provider Business Practice Location Address
First Line	:	2060 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1764
Country	:	US
Telephone Number	:	317-635-3499
Fax Number	:	317-635-0449

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALFREDO MARTIN LOPEZ
Credential	:	MD
Telephone Number	:	317-635-3499

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	04/23/2019

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