Individual
JOHN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1633 N CAPITOL AVE, SUITE 680, INDIANAPOLIS, IN 46202-1261
(317) 962-8851
(317) 962-0335
Mailing address
250 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
01033540
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100236700
—
IN
Enumeration date
06/15/2006
Last updated
01/12/2015
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