Organization
SOUTHERN MEDICAL CORPORATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYLE DAWN SOUTHERN M.D. (PHYSICIAN)
(317) 923-1274
Entity
Organization
Contact information
Practice address
6433 E WASHINGTON ST, SUITE 125, INDIANAPOLIS, IN 46219-6677
(317) 923-1274
(317) 924-4436
Mailing address
6433 E WASHINGTON ST, SUITE 125, INDIANAPOLIS, IN 46219-6677
(317) 923-1274
(317) 924-4436
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01033547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086109
ANTHEM
IN
05
—
100237790A
—
IN
01
—
110014372
RAILROAD MEDICARE
IN
Enumeration date
09/19/2007
Last updated
12/07/2015
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