Basic Information
| Provider Information | |||||||||
| NPI: | 1669493722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA NEPHROLOGY AND INTERNAL MEDICINE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9011 N MERIDIAN ST STE 225 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462605365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175744747 | ||||||||
| FaxNumber: | 3175744737 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460601310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177730363 | ||||||||
| FaxNumber: | 3177708910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 03/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHISTINE | ||||||||
| AuthorizedOfficialFirstName: | JOY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3175642130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 03/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 100226970 | 05 | IN | MEDICAID |