Provider Demographics
NPI:1306935556
Name:MIDWEST EAR INSTITUTE, P.C.
Entity type:Organization
Organization Name:MIDWEST EAR INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-570-7353
Mailing Address - Street 1:7440 N SHADELAND AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2095
Mailing Address - Country:US
Mailing Address - Phone:317-842-4901
Mailing Address - Fax:317-842-4393
Practice Address - Street 1:7440 N SHADELAND AVE STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2095
Practice Address - Country:US
Practice Address - Phone:317-842-4901
Practice Address - Fax:317-842-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INN/A207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000104449OtherANTHEM
1327815OtherUNITED HEALTHCARE
1327815OtherUNITED HEALTHCARE