Provider Demographics
NPI:1083294326
Name:INDIGO HEALTHCARE LLC
Entity Type:Organization
Organization Name:INDIGO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NEELIMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-896-5536
Mailing Address - Street 1:123 NEWPORT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1459
Mailing Address - Country:US
Mailing Address - Phone:215-896-5536
Mailing Address - Fax:
Practice Address - Street 1:150 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9790
Practice Address - Country:US
Practice Address - Phone:215-822-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care