Organization Name: | AFC PHYSICIANS OF INDIANA PC |
NPI Number: | 1518326248 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RANDY JOHANSEN (PRESIDENT) |
Mailing Address: | 7411 N. Keystone Ave. Suite B Indianapolis |
State: | IN US |
Postal Code: | 462403375 |
Phone Number: | 3172594616 |
Fax Number: | 3172594672 |
NPI Enumeration Date: | 02/23/2016 |
NPI Last Update Date: | 02/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |