Organization
OBSIDIAN SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANLEY JOSEPH HARPER MD (MD/PRESIDENT/OWNER)
(317) 399-4567
Entity
Organization
Contact information
Practice address
10090 E US HIGHWAY 36, SUITE D, AVON, IN 46123-8175
(317) 399-4567
Mailing address
1805 BEAUFAIN ST, CARMEL, IN 46032-7202
(317) 399-4567
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01068593A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01068593A
MEDICAL LICENSE
IN
Enumeration date
05/04/2017
Last updated
05/04/2017
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