Organization
INDIANA GASTROENTEROLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL K FREDERICK M.D. (PRESIDENT)
(317) 872-1161
Entity
Organization
Contact information
Practice address
8902 N MERIDIAN ST, STE 225, INDIANAPOLIS, IN 46260-5382
(317) 872-1161
(317) 875-3286
Mailing address
8902 N MERIDIAN ST, STE 225, INDIANAPOLIS, IN 46260-5382
(317) 872-1161
(317) 875-3286
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
50000925A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100057780A
—
IN
01
—
50000925A
INDIANA MEDICAL CORPORATION LICENSE
IN
Enumeration date
10/17/2006
Last updated
09/26/2012
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