MEDICARE: AMERICAN HEALTH NETWORK OF INDIANA, LLC

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	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922119064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH NETWORK OF INDIANA, LLC

Provider Business Mailing Address
First Line	:	6820 PARKDALE PL
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-6601
Country	:	US
Telephone Number	:	317-834-5081
Fax Number	:	317-834-5223

Provider Business Practice Location Address
First Line	:	1215 HADLEY RD
Second Line	:	SUITE 205
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2905
Country	:	US
Telephone Number	:	317-834-1700
Fax Number	:	317-834-1551

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	BEN H PARK
Credential	:	MD
Telephone Number	:	317-580-6307

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/12/2009

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