Basic Information
| Provider Information | |||||||||
| NPI: | 1659774032 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA EMERGENCY PHYSICIANS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 REMIT DR # 1122 | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606751122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002107034 | ||||||||
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| Address1: | 1 SISTERS OF PROVIDENCE | ||||||||
| Address2: | |||||||||
| City: | SAINT MARY OF THE WOODS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478761007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125351051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2014 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | DERIK | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | LLP MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8669165259 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.