Organization
PREMISE HEALTH OF INDIANA MEDICAL, PC
Active
Other names
adidas Indianapolis Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN LEIZMAN MD (PRESIDENT)
(615) 468-6270
Entity
Organization
Contact information
Practice address
8677 IMPACT CT, INDIANAPOLIS, IN 46219-1424
(371) 895-7173
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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