Provider Demographics
NPI:1427495878
Name:INDIAN CREEK FAMILY HEALTH BROOKVILLE LLC
Entity type:Organization
Organization Name:INDIAN CREEK FAMILY HEALTH BROOKVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:765-647-4231
Mailing Address - Street 1:617 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-1280
Mailing Address - Country:US
Mailing Address - Phone:765-647-4231
Mailing Address - Fax:765-547-1414
Practice Address - Street 1:617 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-1280
Practice Address - Country:US
Practice Address - Phone:765-647-4231
Practice Address - Fax:765-547-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty