Provider Demographics
NPI:1861613564
Name:DERMATOLOGY ASSOCIATES OF INDIANA INC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIBBELN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-338-9393
Mailing Address - Street 1:8433 HARCOURT RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2190
Mailing Address - Country:US
Mailing Address - Phone:317-338-9393
Mailing Address - Fax:317-338-9399
Practice Address - Street 1:8433 HARCOURT RD
Practice Address - Street 2:SUITE 310
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2190
Practice Address - Country:US
Practice Address - Phone:317-338-9393
Practice Address - Fax:317-338-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN257660Medicare PIN