Organization
LONGEVITY INSTITUTE OF INDIANA,P.C.
Active
Organization
LONGEVITY INSTITUTE OF INDIANA,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARTHUR J SUMRALL M.D., M.A. (OWNER)
(317) 574-1677
Entity
Organization
Contact information
Practice address
10291 N MERIDIAN ST, SUITE 300, INDIANAPOLIS, IN 46290-1076
(317) 574-1677
(317) 574-1688
Mailing address
10291 N MERIDIAN ST, SUITE 300, INDIANAPOLIS, IN 46290-1076
(317) 574-1677
(317) 574-1688
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01021582A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087198
ANTHEM
IN
Enumeration date
10/10/2007
Last updated
07/03/2014
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