Provider Demographics
NPI:1154541795
Name:INDIANAPOLIS IMMUNIZATION GROUP
Entity type:Organization
Organization Name:INDIANAPOLIS IMMUNIZATION GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-844-2990
Mailing Address - Street 1:1030 E 86TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1866
Mailing Address - Country:US
Mailing Address - Phone:317-844-2990
Mailing Address - Fax:317-844-1706
Practice Address - Street 1:1030 E 86TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1866
Practice Address - Country:US
Practice Address - Phone:317-844-2990
Practice Address - Fax:317-844-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty