Organization
FUNDAMENTAL HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE CHRISTINE MIRANDA LPN (PRACTICE MANAGER)
(765) 838-2310
Entity
Organization
Contact information
Practice address
1221 S CREASY LN STE K3, LAFAYETTE, IN 47905-7430
(765) 838-2310
(765) 838-1035
Mailing address
1221 S CREASY LN STE K3, LAFAYETTE, IN 47905-7430
(765) 838-2310
(765) 838-1035
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114529237
MEN'S HEALTH
IN
01
—
1659312759
NPI
IN
01
—
1942753082
NPI
IN
Enumeration date
11/13/2020
Last updated
02/26/2021
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