Individual
JOHN SCOTT UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8111 S EMERSON AVE STE 101, INDIANAPOLIS, IN 46237-8601
(317) 859-5252
(317) 859-5258
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01086002A
IN
208000000X
Pediatrics Physician
01086002A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010916
MEDICARE PTAN
IN
05
—
300067966
—
IN
Enumeration date
04/20/2017
Last updated
03/24/2025
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