# GRAND OLD DOCS OF THE SOUTHSIDE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Central Indiana Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720277544
- **Authorized official:** ROBERT E DICKS M.D. (MD/OWNER)
- **Authorized official phone:** (317) 882-0535

## Contact information

- **Practice address:** 8920 SOUTHPOINTE DR, SUITE E-1, INDIANAPOLIS, IN 46227-7509
- **Practice address phone:** (317) 882-0535
- **Practice address fax:** (317) 882-0173
- **Mailing address:** 1350 E COUNTY LINE RD, SUITE I, INDIANAPOLIS, IN 46227-0873
- **Mailing address phone:** (317) 882-0535
- **Mailing address fax:** (317) 882-0173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01022713A | IN | Yes |

## Other

- **Enumeration date:** 10/17/2007
- **Last updated:** 06/27/2008