| NPI | 1043405848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNIE T DOTLICH Billing Manager 317-846-4366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01024494) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2010-06-28 |