Provider Demographics
NPI:1386480382
Name:INDIGO MEDICAL, PLLC
Entity type:Organization
Organization Name:INDIGO MEDICAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-824-9818
Mailing Address - Street 1:10224 DURANT RD STE 209
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6468
Mailing Address - Country:US
Mailing Address - Phone:919-322-8255
Mailing Address - Fax:919-646-9674
Practice Address - Street 1:10224 DURANT RD STE 209
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6468
Practice Address - Country:US
Practice Address - Phone:919-322-8255
Practice Address - Fax:919-646-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care