Organization
REGEN 360 INDY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TORI LYNN MATTHEWS MA (MANAGER)
(817) 915-9965
Entity
Organization
Contact information
Practice address
70 E 91ST ST STE 101, INDIANAPOLIS, IN 46240-1550
(312) 972-8307
Mailing address
14251 LANGHAM DR, CARMEL, IN 46074-4401
(312) 972-8307
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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