Individual
CODY LEE EBNIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1500 N RITTER AVE STE 500, INDIANAPOLIS, IN 46219-3027
(317) 942-8636
(317) 921-0237
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003986A
IN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300074168
—
IN
Enumeration date
12/29/2022
Last updated
12/19/2025
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