Organization
PREMISE HEALTH OF INDIANA MEDICAL, P.C.
Active
Other names
SIA Occupational Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
5500 STATE ROAD 38 E, LAFAYETTE, IN 47905-9405
(765) 588-5667
(765) 449-8408
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
02/08/2022
Last updated
08/25/2022
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