Organization
AGELESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WYATT HORSLEY MD (MEDICAL DIRECTOR)
(317) 528-9119
Entity
Organization
Contact information
Practice address
201 PENNSYLVANIA PKWY STE 201, INDIANAPOLIS, IN 46280-1393
(317) 528-9119
Mailing address
201 PENNSYLVANIA PKWY STE 201, INDIANAPOLIS, IN 46280-1393
(317) 528-9119
Taxonomy
Speciality
Code
Description
License number
State
207RB0002X
Obesity Medicine (Internal Medicine) Physician
01076865A
IN
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
Primary
01076865A
IN
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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