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Organization

INTEGRATIVE HEALTH SPECIALIST OF INDIANA PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIM GRIDER BUSINESS OFFICE (BUSINESS ADMINISTRATOR)
(317) 781-3604
Entity
Organization

Contact information

Practice address
9333 N MERIDIAN ST, STE 202, INDIANAPOLIS, IN 46260-1872
(317) 580-9333
(317) 818-8933
Mailing address
9333 N MERIDIAN ST, STE 202, INDIANAPOLIS, IN 46260-1872
(317) 580-9333
(317) 818-8933

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000243460
ANTHEM
IN
01
1558331652
INDIVIDUAL NPI
IN
01
1619947710
INDIVIDUAL NPI
IN
01
1629048715
INDIVIDUAL NPI
IN
Enumeration date
05/22/2006
Last updated
06/25/2013
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