Basic Information
| Provider Information | |||||||||
| NPI: | 1588122162 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7007 GRAHAM RD STE 215 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462204063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743040428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 429 E VERMONT ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462023685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175590950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2019 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | BANKS | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5743040428 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.