Basic Information
| Provider Information | |||||||||
| NPI: | 1841297165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUANG | ||||||||
| FirstName: | BEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D,I, | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PHYSICIANS | ||||||||
| OtherFirstName: | WESTVIEW ER | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7752 TRADERS COVE LN | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462549617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179556263 | ||||||||
| FaxNumber: | 3179207551 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 GUION RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462221616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179207195 | ||||||||
| FaxNumber: | 3179207551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 02001262 | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 02001262 | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 930071191 | 01 | IN | RAILROAD MEDICARE | OTHER | 100339680 | 05 | IN | MEDICAID | 100339680A | 05 | IN | MEDICAID | Q0086911 | 01 | IN | SUBURBAN HEALTH | OTHER | 000000081257 | 01 | IN | BLUE CROSS INDIANA | OTHER | 02001262 | 01 | IN | STATE LICENSE NUMBER | OTHER | 100270690A | 01 | IN | MEDICAID GROUP NO. | OTHER |