Provider Demographics
NPI:1083836332
Name:INDIANAPOLIS PLASTIC SURGEONS PC
Entity Type:Organization
Organization Name:INDIANAPOLIS PLASTIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-872-6760
Mailing Address - Street 1:8330 NAAB ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-872-6760
Mailing Address - Fax:317-879-4029
Practice Address - Street 1:8330 NAAB ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-872-6760
Practice Address - Fax:317-879-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN065880Medicare PIN