| NPI | 1558660464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE DEFUR President 317-338-7031 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207QS0010X Family Medicine, Sports Medicine | |
| 207RS0010X Internal Medicine, Sports Medicine | |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2013-10-01 |