Provider Demographics
NPI:1194066811
Name:INDIANA NEUROSCIENCE ASSOCIATES
Entity type:Organization
Organization Name:INDIANA NEUROSCIENCE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-570-7900
Mailing Address - Street 1:6330 CASTLEPLACE DR
Mailing Address - Street 2:STE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1902
Mailing Address - Country:US
Mailing Address - Phone:317-570-7900
Mailing Address - Fax:317-570-2288
Practice Address - Street 1:1350 E COUNTY LINE RD
Practice Address - Street 2:STE E
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0873
Practice Address - Country:US
Practice Address - Phone:317-570-7900
Practice Address - Fax:317-570-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100072000Medicaid