Provider Demographics
NPI:1003857939
Name:FLANDERS, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:FLANDERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-4836
Mailing Address - Fax:317-962-8646
Practice Address - Street 1:250 N SHADELAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219
Practice Address - Country:US
Practice Address - Phone:317-962-4836
Practice Address - Fax:317-962-8646
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-10-22
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Provider Licenses
StateLicense IDTaxonomies
IN01031754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100334830Medicaid
IN100334830Medicaid