Provider Demographics
NPI:1306884234
Name:INFECTIOUS DISEASE OF INDIANA, PSC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE OF INDIANA, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-582-8180
Mailing Address - Street 1:11455 NORTH MERIDIAN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1680
Mailing Address - Country:US
Mailing Address - Phone:317-582-8180
Mailing Address - Fax:317-582-8185
Practice Address - Street 1:11455 NORTH MERIDIAN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1680
Practice Address - Country:US
Practice Address - Phone:317-582-8180
Practice Address - Fax:317-582-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100237740Medicaid
IN095700Medicare UPIN