Provider Demographics
NPI:1093806333
Name:CENTRAL INDIANA NEUROLOGY, PC
Entity Type:Organization
Organization Name:CENTRAL INDIANA NEUROLOGY, 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:CHRISTOPHER
Authorized Official - Last Name:MELIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-298-4545
Mailing Address - Street 1:1601 MEDICAL ARTS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3458
Mailing Address - Country:US
Mailing Address - Phone:765-298-4545
Mailing Address - Fax:765-298-4945
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3458
Practice Address - Country:US
Practice Address - Phone:765-298-4545
Practice Address - Fax:765-298-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100172680Medicaid
509460Medicare ID - Type Unspecified