Basic Information
| Provider Information | |||||||||
| NPI: | 1588387450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DHP OF INDIANA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1643 NW 136TH AVE. | ||||||||
| Address2: | BLDG. H, SUITE 100 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543772909 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2451 INTELLIPLEX DR | ||||||||
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| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461768580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173923211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2022 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | ADAIR-BLACKWELL, | ||||||||
| AuthorizedOfficialFirstName: | REGINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9543772909 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.