Provider Demographics
NPI:1487342671
Name:JOSEPHSON WALLACK MUNSHOWER NEUROLOGY PC
Entity type:Organization
Organization Name:JOSEPHSON WALLACK MUNSHOWER NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/CIO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-308-2828
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-308-2800
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:330 N WABASH AVE STE 470
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2685
Practice Address - Country:US
Practice Address - Phone:317-308-2800
Practice Address - Fax:765-865-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300074758Medicaid