Provider Demographics
NPI:1003073321
Name:UNIVERSITY FAMILY PHYSICIANS INC
Entity Type:Organization
Organization Name:UNIVERSITY FAMILY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-962-5447
Mailing Address - Street 1:1520 N SENATE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2213
Mailing Address - Country:US
Mailing Address - Phone:317-962-5447
Mailing Address - Fax:317-962-5479
Practice Address - Street 1:1520 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2213
Practice Address - Country:US
Practice Address - Phone:317-962-5447
Practice Address - Fax:317-962-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051762261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11012403AOtherLICENSE
IN11012852AOtherLICENSE
IN11012931AOtherLICENSE
IN11013683AOtherLICENSE
IN11013692AOtherLICENSE
IN11013987AOtherLICENSE
IN11014207AOtherLICENSE
IN11013212AOtherLICENSE
IN11013962AOtherLICENSE
IN11014014AOtherLICENSE
IN11014206AOtherLICENSE
IN1103611AOtherLICENSE
IN11012967AOtherLICENSE
IN11013214AOtherLICENSE
IN11012290AOtherLICENSE
IN11012672AOtherLICENSE
IN11013691AOtherLICENSE
IN11014189AOtherLICENSE
IN11013099AOtherLICENSE
IN11013607AOtherLICENSE
IN11014184AOtherLICENSE
IN11012684AOtherLICENSE
IN11012933AOtherLICENSE
IN11013143AOtherLICENSE
IN11013486AOtherLICENSE
IN11012117AOtherLICENSE
IN11013096AOtherLICENSE
IN11013888AOtherLICENSE
IN11013933AOtherLICENSE
IN11013968AOtherLICENSE
IN11014175AOtherLICAENSE
IN11014209AOtherLICENSE
IN11012633AOtherLICENSE
IN11013101AOtherLICENSE
IN11013402AOtherLICENSE
IN11013625AOtherLICENSE
IN11014152AOtherLICENSE