# EAGLE CREEK DERMATOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053561928
- **Authorized official:** DR. INGRIDA IVETA OZOLS MD (PARTNER)
- **Authorized official phone:** (317) 329-7050

## Contact information

- **Practice address:** 6820 PARKDALE PL, SUITE 211, INDIANAPOLIS, IN 46254-6600
- **Practice address phone:** (317) 329-7050
- **Practice address fax:** (317) 328-6809
- **Mailing address:** 6820 PARKDALE PL, SUITE 211, INDIANAPOLIS, IN 46254-6600
- **Mailing address phone:** (317) 329-7050
- **Mailing address fax:** (317) 328-6809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | 01027554 | IN | — |
| 207NI0002X | Clinical & Laboratory Dermatological Immunology Physician | 01024873 | IN | Yes |
| 207NI0002X | Clinical & Laboratory Dermatological Immunology Physician | 01057248 | IN | — |

## Other

- **Enumeration date:** 09/26/2008
- **Last updated:** 09/11/2013