Organization
GRAND OLD DOCS OF THE SOUTHSIDE
Active
Other names
Central Indiana Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD E DUGGAN MD (PHYSICIAN)
(317) 882-7344
Entity
Organization
Contact information
Practice address
134 N EMERSON AVE, GREENWOOD, IN 46143-9760
(317) 882-7344
(317) 882-4793
Mailing address
1350 E COUNTY LINE RD, SUITE I, INDIANAPOLIS, IN 46227-0873
(317) 882-7344
(317) 882-4793
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5457630004
DME
IN
01
—
CI4722
GROUP RR MEDICARE NUMBER
IN
Enumeration date
10/05/2006
Last updated
09/10/2008
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