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1095 Broad Ripple Ave Suite A Indianapolis IN 46220-2034 | |
| (317) 621-3680 | |
| (317) 621-3689 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1095 Broad Ripple Ave, Indianapolis, Indiana |
| Authorized Official Name and Position | Jeffery Kirkham (CFO) |
| Authorized Official Contact | 3173555822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1095 Broad Ripple Ave Suite A Indianapolis IN 46220-2034 Ph: (317) 621-3680 | 1095 Broad Ripple Ave Suite A Indianapolis IN 46220-2034 Ph: (317) 621-3680 |
| NPI Number | 1982657581 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 12/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982657581 | NPI | - | NPPES |
| 200377090A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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