Provider Demographics
NPI:1568629178
Name:INDIANA UNIVERSITY SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:INDIANA UNIVERSITY SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-402-9554
Mailing Address - Street 1:4024 ELDOR FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8585
Mailing Address - Country:US
Mailing Address - Phone:317-402-9554
Mailing Address - Fax:
Practice Address - Street 1:4024 ELDOR FLOWER DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8585
Practice Address - Country:US
Practice Address - Phone:317-402-9554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012602A284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital