Organization
EMERALD NEURO-RECOVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARET G DUNTEMAN CREDENTIALING DEPT. (BILLING AGENT)
(630) 770-3800
Entity
Organization
Contact information
Practice address
12265 HANCOCK ST STE 42, CARMEL, IN 46032-5801
(317) 606-8778
(317) 740-0534
Mailing address
12265 HANCOCK ST STE 42, CARMEL, IN 46032-5801
(317) 606-8778
(317) 740-0534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000380603
ANTHEM
IN
05
—
104874712
—
MI
05
—
200216290
—
IN
05
—
2617421
—
OH
Enumeration date
11/05/2018
Last updated
09/25/2019
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