# GRAND OLE 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:** 1851487706
- **Authorized official:** GERALD M DEWESTER MD (PHYSICIAN)
- **Authorized official phone:** (317) 882-0535

## Contact information

- **Practice address:** 8921 SOUTHPOINTE DR, B1, INDIANAPOLIS, IN 46227-0968
- **Practice address phone:** (317) 882-0535
- **Practice address fax:** (317) 882-1415
- **Mailing address:** 8921 SOUTHPOINTE DR, B1, INDIANAPOLIS, IN 46227-0968
- **Mailing address phone:** (317) 882-0535
- **Mailing address fax:** (317) 882-1415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01018751A | IN | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 06/30/2008