Provider Demographics
NPI:1043332695
Name:UNIVERSITY PEDIATRIC PLASTIC SURGERY ASSOCIATES, PC
Entity Type:Organization
Organization Name:UNIVERSITY PEDIATRIC PLASTIC SURGERY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, I.U. PLASTIC SURGERY DEPT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:317-274-3636
Mailing Address - Street 1:PO BOX 660105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0001
Mailing Address - Country:US
Mailing Address - Phone:317-278-7019
Mailing Address - Fax:317-481-1337
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EH 232
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-274-3636
Practice Address - Fax:317-278-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty