Individual
DR. JEFFREY R IHLENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 N RONALD REAGAN PKWY, SUITE 141, AVON, IN 46123
(317) 948-3200
(317) 217-2424
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01063183A
IN
208000000X
Pediatrics Physician
01063183A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200856940
—
IN
Enumeration date
08/13/2006
Last updated
03/11/2021
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