Provider Demographics
NPI:1083045744
Name:INDIANA PSYCHIATRY PC
Entity Type:Organization
Organization Name:INDIANA PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-884-1752
Mailing Address - Street 1:8122 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6076
Mailing Address - Country:US
Mailing Address - Phone:317-884-1752
Mailing Address - Fax:317-884-1753
Practice Address - Street 1:8122 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6076
Practice Address - Country:US
Practice Address - Phone:317-884-1752
Practice Address - Fax:317-884-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024942A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201213390Medicaid
IN201213390Medicaid