MEDICARE: DAVID HOGAN CASE MANAGER/CARE CO

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	171M00000X	Case Manager/Care Coordinator		IN

General Provider Information

NPI Number	:	1780076687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HOGAN CASE MANAGER/CARE CO

Provider Business Mailing Address
First Line	:	2105 N MERIDIAN ST
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1491
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

Provider Business Practice Location Address
First Line	:	2105 N MERIDIAN ST
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1491
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

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

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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