Basic Information
| Provider Information | |||||||||
| NPI: | 1659693679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IPEMA | ||||||||
| FirstName: | NEAL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 TOWN CENTER RD S | ||||||||
| Address2: | SUITEB | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461582321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174972300 | ||||||||
| FaxNumber: | 3174972502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2010 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036.123815 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 01071411A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000775099 | 01 | IN | ANTHEM | OTHER | 400280 | 01 | IL | GROUP MEDICARE PTAN | OTHER | 201075840 | 05 | IN | MEDICAID |