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10122 E 10th St Suite 100 Indianapolis IN 46229-2697 | |
| (317) 355-5717 | |
| (317) 355-3760 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 10122 E 10th St, Indianapolis, Indiana |
| Authorized Official Name and Position | Jeffery Kirkham (CFO) |
| Authorized Official Contact | 3173554887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3826 Solutions Ctr Chicago IL 60677-3008 Ph: (317) 355-5837 | 10122 E 10th St Suite 100 Indianapolis IN 46229-2697 Ph: (317) 355-5717 |
| NPI Number | 1689602047 |
|---|---|
| Provider Enumeration Date | 06/28/2006 |
| Last Update Date | 10/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689602047 | NPI | - | NPPES |
| 5085061 | Other | IN | AETNA |
| 100236570A | Medicaid | IN | |
| CA1777 | Other | IN | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Indiana) | Primary |
| 207V00000X | Obstetrics & Gynecology | (Indiana) | Secondary |
| 208000000X | Pediatrics | (Indiana) | Secondary |
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