Organization
GRAND OLD DOCS OF THE SOUTHSIDE
Active
Other names
Central Indiana Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E DICKS M.D. (MD/OWNER)
(317) 882-0535
Entity
Organization
Contact information
Practice address
8920 SOUTHPOINTE DR, SUITE E-1, INDIANAPOLIS, IN 46227-7509
(317) 882-0535
(317) 882-0173
Mailing address
1350 E COUNTY LINE RD, SUITE I, INDIANAPOLIS, IN 46227-0873
(317) 882-0535
(317) 882-0173
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01022713A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI4722
GROUP RR MCE #
IN
Enumeration date
10/17/2007
Last updated
06/27/2008
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