| None | |
|
4946 Lewiston Dr Indianapolis IN 46254-7101 | |
| (765) 729-3735 | |
| Not Available |
| Full Name | None |
|---|---|
| Speciality | Clinic/center |
| Location | 4946 Lewiston Dr, Indianapolis, Indiana |
| Authorized Official Name and Position | Aaron Michael Davis (CEO) |
| Authorized Official Contact | 7657293735 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 4946 Lewiston Dr Indianapolis IN 46254-7101 | None 4946 Lewiston Dr Indianapolis IN 46254-7101 Ph: (765) 729-3735 |
| NPI Number | 1609482041 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 09/21/2020 |
| Certification Date | 09/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609482041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
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