Provider Demographics
NPI:1699875682
Name:DIGESTIVE & LIVER CLINIC, P.C.
Entity type:Organization
Organization Name:DIGESTIVE & LIVER CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HWAN
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:317-650-7454
Mailing Address - Street 1:11805 HARVARD LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4663
Mailing Address - Country:US
Mailing Address - Phone:317-650-7454
Mailing Address - Fax:800-314-7614
Practice Address - Street 1:11805 HARVARD LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4663
Practice Address - Country:US
Practice Address - Phone:317-650-7454
Practice Address - Fax:800-314-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047833A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200373120AMedicaid
IN250070Medicare PIN