1942353362 NPI number — AESTHETIC PLASTIC SURGERY OF INDIANA

Table of content: (NPI 1942353362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942353362 NPI number — AESTHETIC PLASTIC SURGERY OF INDIANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AESTHETIC PLASTIC SURGERY OF INDIANA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942353362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12188A N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-4578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-848-5400
Provider Business Mailing Address Fax Number:
317-848-9314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12188A N MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-4578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-848-5400
Provider Business Practice Location Address Fax Number:
317-848-9314
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LINDERMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
317-848-5400

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  01024839A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000084320 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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