Organization
INDIANA UNIVERSITY MEDICAL GENETICS SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN E HAINLINE MD, PHD (PHYSICIAN)
(317) 274-2966
Entity
Organization
Contact information
Practice address
975 W WALNUT ST, INDIANAPOLIS, IN 46202-5181
(317) 274-2966
Mailing address
250 N SHADELAND AVE, SUITE 130, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207SC0300X
Clinical Cytogenetics Physician
Primary
—
IN
207SG0201X
Clinical Genetics (M.D.) Physician
—
IN
207SG0203X
Clinical Molecular Genetics Physician
—
IN
207SM0001X
Molecular Genetic Pathology (Medical Genetics) Physician
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100460350
—
IN
Enumeration date
05/18/2006
Last updated
08/01/2014
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