Basic Information
| Provider Information | |||||||||
| NPI: | 1881078202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY PHYSICIANS OF INDIANA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3660 GUION RD | ||||||||
| Address2: | SUITE 230B | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462221691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176445005 | ||||||||
| FaxNumber: | 3176445006 | ||||||||
| Practice Location | |||||||||
| Address1: | 3660 GUION RD | ||||||||
| Address2: | SUITE 230B | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462221691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176445005 | ||||||||
| FaxNumber: | 3176445006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAVORKA | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3176211591 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 213E00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.