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Organization
SOUTHSIDE FAMILY MEDICAL GROUP, LLC
Active
Organization
SOUTHSIDE FAMILY MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS A GOUL (PRACTICE MANAGER)
(317) 452-8400
Entity
Organization
Contact information
Practice address
5955 S EMERSON AVE, SUITE 100, INDIANAPOLIS, IN 46237-2600
(317) 789-9600
(317) 789-0600
Mailing address
5955 S EMERSON AVE, SUITE 100, INDIANAPOLIS, IN 46237-2600
(317) 452-8400
(317) 452-8484
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/06/2006
Last updated
10/07/2015
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