| NPI | 1821524059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GOLDBERG Chief Executive Officer 317-205-8202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-05-09 |
| Last Update Date | 2017-05-09 |