Organization
INDY ADVANCE THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERAD DALTON DO (DO)
(317) 818-9000
Entity
Organization
Contact information
Practice address
9245 N MERIDIAN ST STE 225, INDIANAPOLIS, IN 46260-1812
(317) 818-9000
Mailing address
3539 BRUMLEY WAY, CARMEL, IN 46033-3017
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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