# FISHERS CLINIC AND MED SPA LLC

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

## Provider details

- **NPI number:** 1568296481
- **Authorized official:** MANDEEP KAPOOR NP (CEO)
- **Authorized official phone:** (646) 724-9694

## Contact information

- **Practice address:** 13578 E 131ST ST STE 101, FISHERS, IN 46037-6401
- **Practice address phone:** (317) 800-7981
- **Mailing address:** PO BOX 586, GALLOWAY, OH 43119-0586
- **Mailing address phone:** (765) 969-7841

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/02/2024
- **Last updated:** 09/02/2024